title: The Ross procedure in adults: long-term follow-up and echocardiographic changes leading to pulmonary autograft reoperation.
abstract: BACKGROUND
  This is a clinical investigation of the mid- to long-term follow-up of the Ross procedure in adult patients. The primary end point is to explore the incidence and risk factors for a reoperation on the pulmonary autograft. The secondary end points are to explore the incidence of neoaortic root dilation and valve regurgitation, and the echocardiographic profile leading to a reoperation.
  
  
  METHODS
  Ross operations were done in 110 adults who received at least two echocardiographic examinations for a mean follow-up time of 82 months (range, 5 to 155 months). Kaplan-Meier and Cox regression analyses were applied to assess freedom from events and risk factors for events.
  
  
  RESULTS
  Freedom from reoperation on the pulmonary autograft, neoaortic root dilation, and moderate-severe neoaortic valve regurgitation were, respectively, 91.4%, 50%, and 70% at 12 years. The main risk factor for a reoperation was the degree of neoaortic valve regurgitation within the first 2 years of follow-up. Patients requiring an early (<or=4 years) reoperation had early and severe pulmonary autograft valve regurgitation, and no neoaortic root dilation. Patients needing a late (>4 years) reoperation had severe neoaortic root dilation and severe neoaortic valve regurgitation. The left ventricular end-diastolic diameter at the third year of follow-up was a risk factor for late reoperation.
  
  
  CONCLUSIONS
  The Ross operation in adults is a safe procedure with good clinical results in mid- to long-term follow-up. Early reoperations are due to early neoaortic valve regurgitation, wheras late reoperations are due to progressive neoaortic root dilation.
authors.affiliation: Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
authors.forename: Concetta
authors.initials: C
authors.lastname: Carlucci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giamberti
authors.forename: Raul
authors.initials: R
authors.lastname: Abella
authors.forename: Marisa
authors.initials: M
authors.lastname: Di Donato
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004108:Dilatation, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000637:transplantation*; D012372:ROC Curve; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D014182:Transplantation, Autologous; D014463:Ultrasonography