title: Reoperation after the Ross procedure: incidence, management, and survival.
abstract: BACKGROUND
  The risk of reoperation on the autograft and homograft is the major long-term drawback of the Ross procedure. The incidence and clinical implications of reoperations after the Ross procedure are reported.
  
  
  METHODS
  Between March 1992 and February 2010, 336 consecutive patients had a Ross procedure (mean follow-up, 6.2±4.9 years). Autograft implant technique was freestanding root replacement in 269 patients, subcoronary implantation in 52 patients and a modified root replacement with the autograft included in a Valsalva tube graft in 15.
  
  
  RESULTS
  Subsequently, 38 patients (11.3%) underwent reoperations, for autograft dilatation in 23 and a significant autograft insufficiency in 9, at 9.6±3.7 years and 2.6±3.9 years, respectively. Aortic and pulmonary infective endocarditis occurred in 3 patients. Three patients underwent a non valve-related cardiac reoperation. Three patients received a transcatheter pulmonary valve implantation after 12.2±1.7 years. At 15 years, freedoms for autograft and homograft explantation (with 95% confidence interval) were 83.3% (77.4%- to 9.2%) and 92.8% (87.6% to 97.9%), respectively. Native aortic valve regurgitation, indexed aortic annulus diameter exceeding 1.35 cm/m2 and autograft diameter were risk factors for dilated autograft reoperation (hazard ratio, 3.23 [95% confidence interval, 1.19 to 8.81], p=0.02; 3.83 [0.9 to 16.33], p=0.07 and 1.2 per mm [1.01 to 1.41], p=0.03), respectively.
  
  
  CONCLUSIONS
  Autograft dilatation was the leading cause of reoperation in patients who underwent root replacement. Long-term follow-up is mandatory to determine whether modifications of the operative technique could limit autograft dilatation.
authors: Department of Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, Lille, France.
authors: Francis
authors: F
authors: Juthier
authors: André
authors: A
authors: Vincentelli
authors: Claire
authors: C
authors: Pinçon
authors: Carlo
authors: C
authors: Banfi
authors: Pierre V
authors: PV
authors: Ennezat
authors: Sylvestre
authors: S
authors: Maréchaux
authors: Alain
authors: A
authors: Prat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000601:surgery; D001705:Bioprosthesis; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic / Q000453:epidemiology; D004696:Endocarditis / Q000453:epidemiology; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000473:pathology; D014182:Transplantation, Autologous; D016042:Transplantation, Heterotopic; D016896:Treatment Outcome; D055815:Young Adult