Ten-year experience with the Ross operation.
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.
da Costa
Francisco Diniz Affonso
FD
Aliança Saúde Santa Casa, PUCPR, Curitiba, PR, Brazil. fcosta@mps.com.br
Pereira
Elaine Welk Lopes
EW
Barboza
Luiz Eduardo
LE
Haggi Filho
Hermínio
H
Collatusso
Claudinei
C
Gomes
Carlos Henrique Gori
CH
Lopes
Sérgio Augusto Veiga
SA
Sardetto
Evandro Antônio
EA
Ferreira
Andréa Dumsch de Aragon
AD
da Costa
Marise Brenner Affonso
MB
da Costa
Iseu Affonso
IA
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