title: Inclusion cylinder method for aortic valve replacement utilising the Ross operation in adults with predominant aortic stenosis - 99% freedom from re-operation on the aortic valve at 15 years.
abstract: BACKGROUND
  To report our experience with the Ross operation in patients with predominant aortic stenosis (AS) using an inclusion cylinder (IC) method.
  
  
  METHODS
  Out of 324 adults undergoing a Ross operation, 204 patients of mean age of 41.3 years (limits 16-62) underwent this procedure for either AS or mixed AS and regurgitation (AS/AR) between October, 1992 and February, 2012, implanting the PA with an IC method. Clinical follow up and serial echo data for this group is 97% complete with late mortality follow up 99% complete.
  
  
  RESULTS
  There has been zero (0%) early mortality, and late survival at 15 years is 98% (96%, 100%). Only one re-operation on the aortic valve for progressive aortic regurgitation (AR) has been required with freedom from re-operation on the aortic valve at 15 years being 99% (96%, 100%). The freedom from all re-operations on the aortic and pulmonary valves at 15 years is 97% (94%, 100%). Echo analysis at the most recent study shows that 98% have nil, trivial or mild AR. Aortic root size has remained stable, shown by long-term (15 year) echo follow up.
  
  
  CONCLUSIONS
  In an experience spanning 19 years, the Ross operation used for predominant AS using the IC method described, results in 99% freedom from re-operation on the aortic valve at 15 years, better than any other tissue or mechanical valve. For adults under 65 years without significant co-morbidities who present with predominant AS, the pulmonary autograft inserted with this technique gives excellent results.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Skillington
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: M Mostafa
authors.initials: MM
authors.lastname: Mokhles
authors.affiliation: Department of Cardiology Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Wilson
authors.affiliation: Department of Cardiology Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Leeanne
authors.initials: L
authors.lastname: Grigg
authors.affiliation: Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Australia.
authors.forename: Marco
authors.initials: M
authors.lastname: Larobina
authors.affiliation: Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Keefe
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Johanna
authors.initials: J
authors.lastname: Takkenberg
keywords: aortic valve; valve stenosis; valve surgery
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