title: Failed autograft after the ross procedure in children: management and outcome.
abstract: BACKGROUND
  Autograft dilatation (AD) and aortic insufficiency (AI) after the Ross procedure are the most common causes of late autograft failure. The purpose of this study was to examine the results of valve-sparing root replacement (modified David) and composite root replacement.
  
  
  METHODS
  We performed a retrospective review of all children (n=78) undergoing a Ross procedure at our Center from 1993 to 2011.
  
  
  RESULTS
  Median follow-up was 10 years (1to 18 years). Freedom from autograft reoperation was 94% at 5 years, and 65% at 15 years. Freedom from greater than 2+ autograft AI was 93% at 5 years and 76% at 15 years. Autograft reoperation was necessary in 22 patients, at a median interval of 8.7 years after the original procedure. Indications for reoperation were AI with autograft dilatation in 15 patients, AI without dilatation in 2 patients, and AD without AI in 5 patients. Surgical procedures used at reoperation included valve-sparing root replacement in 14 patients, root replacement either mechanical or biologic valved conduit in 6 patients, and valve replacement in 2 patients. At a mean follow-up of 5.8 years after reoperation, 4 patients from the valve-sparing group underwent second reoperation (valve replacement). Freedom from second autograft reoperation was 71% for patients after a valve sparing procedure and 100% for patients after an aortic valve or root replacement (Bentall procedure) at 5 years.
  
  
  CONCLUSIONS
  Autograft valve-sparing root replacement and composite aortic root replacement are effective treatments for aortic root dilation and AI after the Ross procedure. The potential of late autograft insufficiency after valve-sparing root replacement warrants annual follow-up.
authors.affiliation: Children's Hospital of Illinois, OSF Saint Francis Medical Center, and University of Illinois College of Medicine at Peoria, Peoria, Illinois. Electronic address: marksruz@hotmail.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Ruzmetov
authors.affiliation: Children's Hospital of Illinois, OSF Saint Francis Medical Center, and University of Illinois College of Medicine at Peoria, Peoria, Illinois.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
authors.affiliation: Children's Hospital of Illinois, OSF Saint Francis Medical Center, and University of Illinois College of Medicine at Peoria, Peoria, Illinois.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Geiss
authors.affiliation: Children's Hospital of Illinois, OSF Saint Francis Medical Center, and University of Illinois College of Medicine at Peoria, Peoria, Illinois.
authors.forename: Klay
authors.initials: K
authors.lastname: Buckley
authors.affiliation: Children's Hospital of Illinois, OSF Saint Francis Medical Center, and University of Illinois College of Medicine at Peoria, Peoria, Illinois.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Fortuna
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000601:surgery*; D006351:Heart Valves / Q000637:transplantation*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous / Q000009:adverse effects