title: A single-center experience with the ross procedure over 20 years.
abstract: BACKGROUND
  The Ross procedure offers several potential advantages in a young patient population. The widespread use of the procedure is still limited due to the technical challenge. Pulmonary homograft stenosis and autograft dilatation remain a matter of concern. We present the long-term outcome in a single center with special emphasis on mortality and need for valvular reintervention.
  
  
  METHODS
  All patients who received a Ross procedure as freestanding root replacement (modified Yacoub technique) at our institution between 1991 and 2011 were followed. Descriptive statistical methods and Kaplan-Meier analyses were performed.
  
  
  RESULTS
  A total of 246 patients (191 males, 55 females) underwent the Ross procedure during the study period. There were 176 adults and 70 pediatric patients with an average age of 36 ± 10 and 10 ± 5 years, respectively. The median follow-up was 10 years. Twelve (4.9%) subjects were lost to follow-up. Early mortality was 1.6%. Overall mortality was comparable with an age and sex matched population for adult patients. The linearized risk for reoperation per patient-year was 0.6% for the autograft and 0.6% for the right ventricular outflow tract, with a mean time to surgery of 6.4 ± 4.9 years. Overall freedom from reintervention was 95% at 5 years, 88% at 10 years, and 81% at 15 years.
  
  
  CONCLUSIONS
  The Ross procedure provides good early results and an excellent long-term survival. It represents an excellent method of aortic valve replacement in children and young adults. Root reinforcement techniques and aortic reduction plasty may be beneficial, especially in adult patients with native aortic valve regurgitation.
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: martin.andreas@meduniwien.ac.at.
authors.forename: Martin
authors.initials: M
authors.lastname: Andreas
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Gernot
authors.initials: G
authors.lastname: Seebacher
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Eric
authors.initials: E
authors.lastname: Reida
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Dominik
authors.initials: D
authors.lastname: Wiedemann
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Christiane
authors.initials: C
authors.lastname: Pees
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosenhek
authors.affiliation: Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.affiliation: Department of Thoracic, Cardiac and Thoracovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Alfred
authors.initials: A
authors.lastname: Kocher
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011664:Pulmonary Valve / Q000601:surgery / Q000637:transplantation*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult