title: An evaluation of the Ross operation in adults.
abstract: OBJECTIVE
  Pulmonary autograft replacement of the aortic valve (the Ross operation) is the operation of choice in infants and children. Although this procedure can offer theoretical advantages at any age, its use in adults remains controversial.
  
  
  METHODS
  A total of 264 consecutive patients (203 males, 61 females; mean age 35.0 +/- 11.5 years; range: 18-66 years) was studied. These patients underwent the Ross operation at two institutions and were followed up for a total of 1,634 patient-years. The etiology was mainly congenital (52%), degenerative (22%), and rheumatic (8%). Among patients, 21% underwent prior aortic valve replacement.
  
  
  RESULTS
  Thirty-day mortality was 2.3% (n = 6), and four more patients died during follow up (mean follow up 6.2 years; range 0-15.4 years). Cumulative survival at five years was 96.8%, and at 10 years was 95.4%. Eleven patients underwent reoperation on the aortic valve; this was due to progressive dilatation and aortic regurgitation in 10 cases, and to dissection of the arterial wall of the autograft in one case. Overall freedom from pulmonary homograft reoperation was 94.9% at 10 years, and for autograft reoperation was 92.9%. Estimated freedom from autograft reoperation at Harefield was 98.6% at five and 10 years, and at Rotterdam 96.0% at five years and 88.2% at 10 years (p = 0.10, Tyrone-Ware). No risk factors for early and late mortality and reoperation were detected.
  
  
  CONCLUSIONS
  In this combined series, the Ross operation in adult patients resulted in excellent survival and acceptable reoperation rates. A prospective randomized trial is proposed to study whether this observation truly reflects the potential advantages of the Ross procedure, or whether it is caused by patient selection.
authors.affiliation: Harefield Heart Science Center, NHLI, UK. m.yacoub@imperial.ac.uk
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
authors.forename: Loes M A
authors.initials: LM
authors.lastname: Klieverik
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melina
authors.forename: Sue E R
authors.initials: SE
authors.lastname: Edwards
authors.forename: Padmini
authors.initials: P
authors.lastname: Sarathchandra
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.forename: Umberto
authors.initials: U
authors.lastname: Squarcia
authors.forename: Guido
authors.initials: G
authors.lastname: Sani
authors.forename: Lex A
authors.initials: LA
authors.lastname: van Herwerden
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D004452:Echocardiography; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000637:transplantation*; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate; D013536:Suture Techniques; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome