title: Ross procedure in adults: is reoperation a real concern?
abstract: OBJECTIVE
  Reintervention after the Ross procedure (RP) remains a concern. Hence, the study aim was to assess the long-term results of the RP in adults and to identify predictors of reoperation.
  
  
  METHODS
  Between 1995 and 2012, a total of 263 consecutive patients (189 males, 74 females; mean age 42 ± 14 years) underwent the RP, using the free-standing root technique. The mean follow up was 7.5 ± 5.0 years and was 94% complete. Survival, and freedom from autograft, homograft and Ross-related reoperation were analyzed using Kaplan-Meier analysis, while Cox proportional hazard regression was used to identify predictors of reoperation.
  
  
  RESULTS
  Early mortality was 2.6% (n = 7) and late mortality 4.9% (n = 14). Survival at 13 years was 90% (95% CI 80-95%). Freedom from homograft, autograft and Ross-related reoperation at 13 years were 97% (95% CI 90-99%), 92% (95% CI 82-96%) and 90% (95% CI 81-95%), respectively. No predictors of homograft reoperation were identified. Freedom from autograft reoperation was not significantly different for patients with preoperative aortic insufficiency (AI) (88%; 95% CI 74-95% at 13 years) compared to those with aortic stenosis (96%; 95% CI 84-99% at 13 years), or both (86%; 95% CI 51-97% at 13 years) (p = 0.62). Other variables (gender, aortic/pulmonary mismatch and aortic annulus diameter) were not significantly associated with the need for autograft reoperation.
  
  
  CONCLUSIONS
  Despite its complexity and reoperation rate, RP should be considered as a valid surgical option for aortic valve disease treatment in selected patients. Among the present series, no predictors for homograft or autograft reoperation were identified.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Escarain
authors.forename: Gustavo
authors.initials: G
authors.lastname: Giunta
authors.forename: Roberto R
authors.initials: RR
authors.lastname: Favaloro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D064592:Autografts; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011664:Pulmonary Valve / Q000637:transplantation; D012086:Reoperation; D055815:Young Adult