title: Aortic valve replacement: ten-year follow up of the Ross procedure.
abstract: OBJECTIVE
  The study aim was to assess the long-term results of the Ross procedure in the treatment of aortic valve disease.
  
  
  METHODS
  Between July 1995 and May 2006, a total of 165 patients (131 males, 34 females; mean age 39 +/- 13 years) underwent the Ross procedure using the freestanding root technique. Both, clinical and echocardiographic follow ups were conducted, with valve-associated events (death, endocarditis, thromboembolism, reoperation, valvular dysfunction) being analyzed using Kaplan-Meier curves. Log-rank tests, chi-square tests and the Cox model were used for variable analysis.
  
  
  RESULTS
  The mean preoperative left ventricular ejection fraction was 55 +/- 12%. Surgery was indicated for aortic stenosis (54%) or aortic insufficiency (46%). The aortic valve was bicuspid in 125 patients, while in four patients surgery was indicated in the setting of active infective endocarditis, and in six for prosthetic dysfunction. The in-hospital mortality was 2.5% (n = 4). Survival at one and 10 years was 97% (95% CI, 93-99) and 94.8% (95% CI, 89-98), respectively. Freedom from endocarditis at 10 years was 95% (95% CI, 84-98), and from valve-related events was 95% (95% CI, 90-98) and 88% (95% CI, 75-94) at one and 10 years, respectively. Four patients required reoperation (one case of recurrent mitral regurgitation after previous mitral valve repair; three cases of autograft dysfunction and disease of other valves). Based on this experience, and during the follow up period, the presence of aortic regurgitation as a baseline aortic lesion was not associated with any need for reoperation.
  
  
  CONCLUSIONS
  As a surgical technique, the Ross procedure has a low event rate at 10 years after surgery, and may be considered a valid alternative for the treatment of aortic valve disease.
authors.affiliation: Favaloro University Hospital, Buenos Aires, Argentina. rfavaloro@ffavaloro.org
authors.forename: Roberto R
authors.initials: RR
authors.lastname: Favaloro
authors.forename: Pablo
authors.initials: P
authors.lastname: Roura
authors.forename: Carmen
authors.initials: C
authors.lastname: Gomez
authors.forename: Carolina
authors.initials: C
authors.lastname: Salvatori
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D011664:Pulmonary Valve / Q000637:transplantation*; D012008:Recurrence; D012086:Reoperation; D014463:Ultrasonography; D055815:Young Adult