title: Midterm results of Ross aortic valve replacement: a single-institution experience.
abstract: BACKGROUND
  We reviewed our institutional midterm experience to assess autograft and homograft hemodynamics and reoperative frequency after Ross aortic valve replacement.
  
  
  METHODS
  Between June 1993 and January 2009, 212 consecutive patients (mean age, 24.8 +/- 15.5 years; range, 1 month to 67 years) underwent Ross aortic valve replacement; 49% were younger than 19 years old. One hundred forty-two additional procedures were required in 101 of the 212 patients (48%) at the time of the Ross aortic valve replacement. One hundred ninety-three patients had isolated aortic valve disease, and 19 pediatric patients had more complex, multilevel left ventricular outflow tract obstruction.
  
  
  RESULTS
  There were 2 early (1%) and 2 late deaths (1%), with a mean follow-up of 7.9 +/- 4.2 years (range, 1 month to 15 years). Actuarial survival at 15 years was 98%. To date 28 patients (13%) have required reoperation. At 15 years, freedom from autograft sinus or ascending aortic dilatation was 79%, autograft dysfunction, 91%, autograft reoperation, 89%, and autograft replacement, 96%. Freedom from pulmonary allograft replacement was 96% at 15 years.
  
  
  CONCLUSIONS
  The Ross aortic valve replacement can be performed in children and adults with good midterm results. The late complications of autograft regurgitation, sinus or ascending aortic dilatation, can usually be corrected with a valve-sparing root replacement. These complications can often be prevented by (1) aggressive treatment of postoperative systemic hypertension, (2) replacement of a dilated ascending aorta at the initial Ross procedure, or (3) external fixation of the autograft annulus or sinotubular junction. The potential of late autograft insufficiency, ascending aortic and sinus dilatation, or homograft stenosis and insufficiency warrants annual follow-up.
authors.affiliation: Sections of Cardiothoracic Surgery, James W. Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana 46202-5123, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Brown
authors.forename: Mark
authors.initials: M
authors.lastname: Ruzmetov
authors.forename: Ali
authors.initials: A
authors.lastname: Shahriari
authors.forename: Mark D
authors.initials: MD
authors.lastname: Rodefeld
authors.forename: Yousuf
authors.initials: Y
authors.lastname: Mahomed
authors.forename: Mark W
authors.initials: MW
authors.lastname: Turrentine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult