title: A 17-year, single-centre experience with the Ross procedure: fulfilling the promise of a durable option without anticoagulation?
abstract: OBJECTIVE
  For adult patients <60 years with aortic valve disease, the Ross procedure is an attractive alternative to a prosthetic aortic valve. The Ross procedure enables surgeons to achieve a haemodynamically ideal aortic valve replacement. A potential drawback may be long-term durability, which varies considerably between series.
  
  
  METHODS
  Between 1996 and 2014, 209 patients (mean age, 43 ± 10 years) underwent an elective Ross procedure in our department. In 78% (n = 161) of patients a bicuspid valve was found. Patients were examined clinically and with echocardiography during the follow-up. The mean follow-up was 7.9 ± 5 years and was 98% complete.
  
  
  RESULTS
  The 30-day mortality rate was 2.4% (n = 5). The Kaplan-Meier survival rates at 10 and 15 years were 91 and 85%, respectively. In 17 patients (8.3%) the pulmonary autograft had to be reoperated on: 12 of them could be repaired; only 5 patients finally underwent prosthetic valve replacement. The rate of freedom from reoperation for autograft failure was 93% and that from reoperation or moderate autograft regurgitation was 87% at 10 years. Thromboembolic events occurred in 9 patients (0.54%/patient-year) and were mostly related to atrial fibrillation. Endocarditis involving the pulmonary autograft was observed in 6 patients (0.36%/patient-year).
  
  
  CONCLUSIONS
  Pulmonary autograft aortic root replacement to treat patients with severe aortic valve dysfunction is a challenging procedure. The reoperation rate is higher compared with mechanical valve replacement; however, in the majority of patients with reoperations in our series the autograft could be saved. Other valve-related complications are rare.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang-Goethe University Hospital, Frankfurt, Germany miskovic@gmx.net.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Miskovic
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang-Goethe University Hospital, Frankfurt, Germany.
authors.forename: Nadejda
authors.initials: N
authors.lastname: Monsefi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang-Goethe University Hospital, Frankfurt, Germany.
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Karimian-Tabrizi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang-Goethe University Hospital, Frankfurt, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang-Goethe University Hospital, Frankfurt, Germany.
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation / Q000706:statistics & numerical data; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aortic valve disease; Outcome; Ross procedure