title: The Ross operation: an evaluation of a single institution's experience.
abstract: BACKGROUND
  Pulmonary autograft aortic root replacement was used in adults. Risk factors for aortic valve incompetence (AI) and pulmonary homograft valve stenosis are identified.
  
  
  METHODS
  From February 1991 through May 2003, 103 patients, with a mean age of 35.2 +/- 9.5 years, underwent aortic root replacement with the pulmonary autograft. Annulus reinforcement (reduction annuloplasty or use of root ring) was carried out in 45 patients. In all but 1 patient, the right ventricular outflow tract was reconstructed with a cryopreserved pulmonary homograft. Mean follow-up duration was 6.0 +/- 2.8 years (range 0.3 to 11 years).
  
  
  RESULTS
  There were no hospital deaths. Overall patient survival was 98.9 +/- 1.0% at 1 year and 97.3 +/- 1.9% at 10 years. Autograft function follow-up resulted in 5 patients requiring reoperation for aortic incompetence. The univariate risk factors for aortic incompetence at discharge and during follow-up were respectively annulus reinforcement (p = 0.05) and bicuspic aortic valve (p = 0.05). Reoperation for homograft failure occurred in 1 patient. During follow-up, 24 patients (25.5%) developed homograft stenosis (gradient > 20 mm Hg). Univariate analysis indicated the diameter of the homograft (p = 0.001) as factor associated with stenosis during follow-up. Cox regression identified smaller diameter of the homograft (p = 0.001) and older age of donor (p = 0.002) as independent risk factor for the development of homograft stenosis.
  
  
  CONCLUSIONS
  The Ross operation can be performed with few complications. Although both the aortic autograft and the pulmonary homograft have limited durability, this has not yet resulted in considerable reoperation rates and associated morbidity and mortality.
authors.affiliation: Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. sieben2000@yahoo.com
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Settepani
authors.forename: Abdullah
authors.initials: A
authors.lastname: Kaya
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Morshuis
authors.forename: Marc A
authors.initials: MA
authors.lastname: Schepens
authors.forename: Robin H
authors.initials: RH
authors.lastname: Heijmen
authors.forename: Karl M
authors.initials: KM
authors.lastname: Dossche
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D014182:Transplantation, Autologous; D016896:Treatment Outcome