title: Long-Term Follow-Up After the Ross Procedure: A Single Center 22-Year Experience.
abstract: BACKGROUND
  The aim of this study was to analyze long-term outcomes after the Ross procedure, focusing on autograft function and risk of reoperation in time.
  
  
  METHODS
  Between February 1994 and February 2016, 154 patients underwent the Ross (n = 105) and Ross-Konno (n = 49) procedure at our institution and were included in this study. Data were collected retrospectively from patients' medical records or through telephone contact. Competing risks analyses were performed to determine incidences of death and reoperation. A multistate model was constructed to provide insights in the clinical trajectory after operation.
  
  
  RESULTS
  Median age was 12 years, 74% were pediatric patients, and 66% had previous surgical procedures. There were 8 (5%) early deaths, 6 of whom underwent the Ross-Konno procedure, and 10 (7%) late deaths. Survival rates at 15 and 20 years were 86% in the total cohort and 91% in the isolated Ross subgroup. Linearized occurrence rates of endocarditis and valve thrombosis, thromboembolism, and bleeding events combined were 0.30% per patient-year and 0.15% per patient-year, respectively. Cumulative incidences of all-cause reoperation at 15 and 20 years were 35.2% and 45.3%, respectively. Twenty-six patients needed autograft reoperation, 20 due to dilatation. Cumulative incidences of autograft reoperation at 15 and 20 years were 20.1% and 31.1%, respectively. At latest echocardiogram, 4 patients had moderate aortic regurgitation and none had stenosis.
  
  
  CONCLUSIONS
  The Ross procedure can be performed safely in young patients with low number of valve-related events. Autograft function remains stable in the first decade after operation, but autograft dilatation in the second decade necessitates reintervention.
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.w.schneider@lumc.nl.
authors.forename: Adriaan W
authors.initials: AW
authors.lastname: Schneider
authors.affiliation: Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Robert J M
authors.initials: RJM
authors.lastname: Klautz
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Eline F
authors.initials: EF
authors.lastname: Bruggemans
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Regina
authors.initials: R
authors.lastname: Bökenkamp
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D064592:Autografts; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011664:Pulmonary Valve / Q000601:surgery / Q000637:transplantation*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D016277:Ventricular Function, Left; D055815:Young Adult