title: The Ross procedure: clinical and echocardiographic follow-up in 219 consecutive patients.
abstract: BACKGROUND
  The replacement of the diseased aortic valve with a pulmonary autograft has been shown to provide excellent hemodynamic results and to be associated with low morbidity and mortality rates.
  
  
  METHODS
  From 1991 to 2005, 219 patients undergoing the Ross operation were identified. All patients underwent transthoracic echocardiography at discharge and were scheduled for a yearly study thereafter. The echocardiographic study consisted of a morphologic analysis of the pulmonary autograft with measurement of end-systolic diameters at three levels: annulus, sinuses of Valsalva, and origin of the ascending aorta 2 cm above the sinotubular junction. The dynamic analysis evaluated the function of the aortic autograft and the pulmonary homograft. Maximal and mean aortic and pulmonary transvalvular pressure gradients were investigated.
  
  
  RESULTS
  The 30-day mortality was 1.8% (n = 4). Cardiac deaths were not related to the autograft. The 10-year actuarial survival was 95.7% +/- 2.1%. Six patients (2.8%) had grade 2 autograft valve regurgitation. No grade 3 or 4 pulmonary regurgitation was identified. At their most recent follow-up, 28 patients (13.1%) had grade 1 insufficiency of the pulmonary homograft, and 10 patients (4.6%) had a peak transvalvular gradient of 17.9 +/- 10.2 mm Hg.
  
  
  CONCLUSIONS
  Our current experience suggests that replacement of the aortic root with a pulmonary autograft can be safely performed in infants, children, and adults and is associated with low mortality and morbidity rates. It constitutes an elegant alternative to the use of prosthetic valves in the treatment of aortic valve diseases.
authors: Department of Thoracic and Cardiovascular Surgery, Saint Luc Hospital, Université Catholique de Louvain, Brussels, Belgium. bruno_chiappini@hotmail.com
authors: Bruno
authors: B
authors: Chiappini
authors: Bruno
authors: B
authors: Absil
authors: Jean
authors: J
authors: Rubay
authors: Philippe
authors: P
authors: Noirhomme
authors: Jean-Christophe
authors: JC
authors: Funken
authors: Robert
authors: R
authors: Verhelst
authors: Alain
authors: A
authors: Poncelet
authors: Gebrine
authors: G
authors: El Khoury
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D016016:Proportional Hazards Models; D011664:Pulmonary Valve / Q000637:transplantation*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D014182:Transplantation, Autologous