title: 20 years experience with the Ross operation in middle-aged patients: the autologous principle is still alive.
abstract: Review our long-term results with the Ross operation in middle-aged patients.
  
  
  
  Between 1995 and 2016, 129 consecutive patients (106 males); mean age (47.2 ± 5.2 years) underwent a Ross operation. Right ventricular outflow tract (RVOT) reconstruction was performed with cryopreserved (n = 45) or decellularized allografts (n = 84). Mean follow-up was 8.4 ± 5.3 years (0.1 20.5 years). We analyzed early and late mortality, as well as valve related events and the need for reoperations.
  
  
  
  Early mortality was 1.6% and late survival was 87.6% at 16 years. There were 4 reoperations on the pulmonary autograft (96% freedom at 16 years) and 2 on the pulmonary allografts (99% freedom at 16 years). The 16-year freedom from more than mild aortic insufficiency (AI) and a late root diameter >45 mm was 64% and 71%, respectively. Patients with the preoperative diagnosis of AI are at greater risk for these complications. Among the allografts, decellularized allografts showed superior freedom from structural valve dysfunction.
  
  
  
  The Ross operation in this cohort was associated with long-term survival similar to the general population and low incidence of reoperations. Patients with the preoperative diagnosis of AI are at increased risk for late autograft insufficiency and root dilatation. Decellularized allografts presented the best results for reconstruction of the RVOT. These results support the conclusion that the Ross operation has an important role in the treatment of middle-aged patients with aortic valve disease, especially those with pure aortic stenosis.
authors.affiliation: Department of Cardiovascular Surgery, Instituto de Neurologia e Cardiologia de Curitiba, Curitiba, Paraná, Brazil.|Department of Cardiovascular Surgery, Santa Casa de Curitiba, PUCPR, Curitiba, Paraná, Brazil.
authors.forename: Francisco Diniz Affonso da
authors.initials: FD
authors.lastname: Costa
authors.affiliation: Department of Cardiovascular Surgery, Instituto de Neurologia e Cardiologia de Curitiba, Curitiba, Paraná, Brazil.
authors.forename: Daniele Fornazari
authors.initials: DF
authors.lastname: Colatusso
authors.affiliation: Department of Cardiovascular Surgery, Instituto de Neurologia e Cardiologia de Curitiba, Curitiba, Paraná, Brazil.
authors.forename: Eduardo Mendel
authors.initials: EM
authors.lastname: Balbi Filho
authors.affiliation: Department of Cardiovascular Surgery, Instituto de Neurologia e Cardiologia de Curitiba, Curitiba, Paraná, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Marchetti
authors.affiliation: Department of Cardiovascular Surgery, Santa Casa de Curitiba, PUCPR, Curitiba, Paraná, Brazil.
authors.forename: Andreia Dumsch de Aragon
authors.initials: AD
authors.lastname: Ferreira
authors.affiliation: Department of Cardiovascular Surgery, Santa Casa de Curitiba, PUCPR, Curitiba, Paraná, Brazil.
authors.forename: Marise Brenner Affonso da
authors.initials: MB
authors.lastname: Costa
authors.affiliation: Department of Cardiovascular Surgery, Santa Casa de Curitiba, PUCPR, Curitiba, Paraná, Brazil.
authors.forename: Joao Gabriel
authors.initials: JG
authors.lastname: Roderjan
authors.affiliation: Department of Cardiovascular Surgery, Santa Casa de Curitiba, PUCPR, Curitiba, Paraná, Brazil.
authors.forename: Claudinei
authors.initials: C
authors.lastname: Colatusso
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000637:transplantation*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: Aortic valve; Decellularization; Pulmonary allografts; Pulmonary autograft; Tissue engineering