title: Results of the Ross procedure in adults: a single-centre experience of 741 operations.
abstract: OBJECTIVE
  Although the Ross procedure provides excellent long-term survival and a high quality of life, only a limited number of centres perform it as an alternative to the standard aortic valve replacement in adults. In the present study, we evaluated our 16-year results of using the Ross procedure in adult patients.
  
  
  METHODS
  Between 1998 and 2014, 741 adult patients underwent the Ross procedure. The mean patient age was 47.4 ± 12.8 years (range, 18-67 years). The total root replacement technique was used in all patients. Right ventricular outflow tract (RVOT) reconstruction was performed with pulmonary allograft in 175 (23.6%) patients, with different types of xenografts in 561 (75.7%) and with polytetrafluoroethylene conduits in 5 (0.7%) patients.
  
  
  RESULTS
  The early mortality rate was 3.0%. The mean follow-up duration was 5.8 ± 2.2 years. The survival rate at 10 years was 90.7% and was comparable with survival of an age- and sex-matched general population. The rate of freedom from autograft reoperations was 94.1 and 88.3% at 5 and 10 years, respectively. The aortic annulus dilatation was the only independent predictor of autograft failure. The 10-year freedom rates from reoperations for allograft, diepoxide- and glutaraldehyde-treated pericardial xenografts as well as porcine aortic root grafts were 100, 94.4, 82.7 and 80.6%, respectively. The use of xenografts and young patient age were associated with increased risk of RVOT conduit failure.
  
  
  CONCLUSIONS
  The Ross operation provides long-term survival rates that are comparable with an age- and gender-matched general population. The dilated aortic annulus is a risk factor for late autograft valve insufficiency. A cryopreserved pulmonary homograft is the best option for RVOT reconstruction. Diepoxide-treated pericardial xenografts can be an alternative to allografts in elderly patients when an allograft is not available.
authors.affiliation: Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Alexander
authors.initials: A
authors.lastname: Karaskov
authors.affiliation: Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation ravil-sharifulin@rambler.ru.
authors.forename: Ravil
authors.initials: R
authors.lastname: Sharifulin
authors.affiliation: Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Sergey
authors.initials: S
authors.lastname: Zheleznev
authors.affiliation: Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Igor
authors.initials: I
authors.lastname: Demin
authors.affiliation: Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Lenko
authors.affiliation: Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bogachev-Prokophiev
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D055815:Young Adult
keywords: Aortic valve replacement; Outcome; Ross operation; Xenograft