title: Long-term results of the Ross operation: an 18-year single institutional experience.
abstract: OBJECTIVE
  The purpose of the study was to assess the 18-year outcome of the Ross operation (RO), with emphasis on survival, reoperations, and late function of the pulmonary autografts (PAs) and the right-sided pulmonary allografts.
  
  
  METHODS
  Between May 1995 to July 2013, 414 patients with a mean age (mean ± standard deviation) of 30.8 ± 13.1 years were submitted to an RO with the root replacement (n = 356) or the inclusion (n = 58) technique. The most prevalent aetiology was bicuspid valve (n = 206, 49.8%). Patients were divided in four groups depending on the type of allograft used on the right side. The mean follow-up was 8.2 ± 5.2 years and was 97.7% complete. In addition to longitudinal outcomes determined by means of the Kaplan-Meier analysis, log-rank test and Cox regression analysis were used to identify predictors of valve failure.
  
  
  RESULTS
  The early mortality rate was 2.7% and the late survival rate was 89.3% at 15 years, similar to an age- and sex-matched population. There were 22 reoperations on the PA (90.7% freedom at 15 years) and 15 on the pulmonary allografts (92.5% freedom at 15 years). The freedom rate from more than mild aortic insufficiency (AI) was 73.1% at 15 years. Thirty-three patients presented with a late root diameter >45 mm, corresponding to a freedom rate of 72.4% at 15 years. Patients with AI and a dilated annulus, especially males, are at greater risk for these complications. Among the right-sided allografts, fresh decellularized allografts showed significantly superior freedom from structural valve dysfunction.
  
  
  CONCLUSIONS
  The RO was associated with excellent long-term survival and low incidence of reoperations up to 15 years. Male patients with AI and dilated annulus are at increased risk for late insufficiency and root dilatation. Fresh decellularized allografts presented the best results for reconstruction of the right ventricular outflow tract.
authors.affiliation: Department of Cardiovascular Surgery of Santa Casa de Curitiba - PUCPR, Curitiba, Brazil fcosta13@mac.com.
authors.forename: Francisco Diniz Affonso
authors.initials: FD
authors.lastname: da Costa
authors.affiliation: Department of Cardiovascular Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Johanna Josepha Maria
authors.initials: JJ
authors.lastname: Takkenberg
authors.affiliation: Department of Cardiovascular Surgery of Santa Casa de Curitiba - PUCPR, Curitiba, Brazil.
authors.forename: Daniele
authors.initials: D
authors.lastname: Fornazari
authors.affiliation: Department of Cardiovascular Surgery of Santa Casa de Curitiba - PUCPR, Curitiba, Brazil.
authors.forename: Eduardo Mendel
authors.initials: EM
authors.lastname: Balbi Filho
authors.affiliation: Department of Cardiovascular Surgery of Santa Casa de Curitiba - PUCPR, Curitiba, Brazil.
authors.forename: Claudinei
authors.initials: C
authors.lastname: Colatusso
authors.affiliation: Department of Cardiovascular Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Mohammad Mostafa
authors.initials: MM
authors.lastname: Mokhles
authors.affiliation: Department of Cardiovascular Surgery of Santa Casa de Curitiba - PUCPR, Curitiba, Brazil.
authors.forename: Ana Beatriz Brenner Affonso
authors.initials: AB
authors.lastname: da Costa
authors.affiliation: Department of Cardiovascular Surgery of Santa Casa de Curitiba - PUCPR, Curitiba, Brazil.
authors.forename: Andressa Gervasoni
authors.initials: AG
authors.lastname: Sagrado
authors.affiliation: Department of Cardiovascular Surgery of Santa Casa de Curitiba - PUCPR, Curitiba, Brazil.
authors.forename: Andreia Dumsch de Aragon
authors.initials: AD
authors.lastname: Ferreira
authors.affiliation: Department of Cardiovascular Surgery of Santa Casa de Curitiba - PUCPR, Curitiba, Brazil.
authors.forename: Tiago
authors.initials: T
authors.lastname: Fernandes
authors.affiliation: Department of Cardiovascular Surgery of Santa Casa de Curitiba - PUCPR, Curitiba, Brazil.
authors.forename: Sergio Veiga
authors.initials: SV
authors.lastname: Lopes
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000502:physiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D011664:Pulmonary Valve / Q000637:transplantation; D012086:Reoperation; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Decellularization; Pulmonary autograft; Surgery; Tissue engineering; Valves