title: Ten-year experience with the Ross operation.
abstract: OBJECTIVE
  To evaluate the 10-year outcomes of the Ross Operation, analyzing survival rate, incidence of reoperations, and late performance of pulmonary autografts and homografts in the reconstruction of the right ventricular outflow tract.
  
  
  METHODS
  Two hundred and twenty seven patients with a mean age of 29.1 +/- 11 years underwent Ross operation from May 1995 to February 2005. The most prevalent etiology was rheumatic disease in 61% of the cases. Autografts were implanted using the total root replacement technique in 202 cases, with intraluminal cylinder in 20, and in the subcoronary position in 5. The right ventricular outflow tract was conventionally reconstructed with cryopreserved homografts (n = 160), with proximal extension of the homograft with pericardium (n = 41), and with decellularized homografts (n = 26). The postoperative follow-up ranged from 1 to 118 months (mean = 45.5 months).
  
  
  RESULTS
  Hospital mortality was 3.5%, and long-term survival was 96.9% at ten years. No episodes of thromboembolism and only two cases of endocarditis occurred. Eleven patients underwent reoperation because of problems related to the auto and/or homograft, progression of rheumatic mitral valve disease, and iatrogenic coronary insufficiency. After 10 years, 96.4% and 96.2% of the patients were free from reoperation in the autograft and homograft groups, respectively. No late autograft dilatation was observed. Reconstruction of the left ventricular outflow tract with decellularized homografts significantly reduced the incidence of gradients on late follow-up.
  
  
  CONCLUSIONS
  Late outcomes with the Ross Operation were associated with an excellent long-term survival and a low incidence of reoperations and late morbidity. We consider this procedure the best option for the surgical treatment of aortic valve disease in children and young adults.
authors.affiliation: Aliança Saúde Santa Casa, PUCPR, Curitiba, PR, Brazil. fcosta@mps.com.br
authors.forename: Francisco Diniz Affonso
authors.initials: FD
authors.lastname: da Costa
authors.forename: Elaine Welk Lopes
authors.initials: EW
authors.lastname: Pereira
authors.forename: Luiz Eduardo
authors.initials: LE
authors.lastname: Barboza
authors.forename: Hermínio
authors.initials: H
authors.lastname: Haggi Filho
authors.forename: Claudinei
authors.initials: C
authors.lastname: Collatusso
authors.forename: Carlos Henrique Gori
authors.initials: CH
authors.lastname: Gomes
authors.forename: Sérgio Augusto Veiga
authors.initials: SA
authors.lastname: Lopes
authors.forename: Evandro Antônio
authors.initials: EA
authors.lastname: Sardetto
authors.forename: Andréa Dumsch de Aragon
authors.initials: AD
authors.lastname: Ferreira
authors.forename: Marise Brenner Affonso
authors.initials: MB
authors.lastname: da Costa
authors.forename: Iseu Affonso
authors.initials: IA
authors.lastname: da Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome