Highlights of a ten-year experience with the Ross procedure

Background. A review of a 10-year experience with the Ross procedure as a r oot replacement by a single group of surgeons featuring specific highlights is presented. Highlights include our results from a subset of patients wit h endocarditis and their management and a comparison of outcomes in patient s with aortic insufficiency based on technical changes made after 5 years' experience. Methods. The total patient group was 191, with 148 male and 43 female parti cipants with an age range from 1 day to 69 years. Five of the patients in t he 0-to-20 age group were newborns. Fifty-three of the adults were operated on for infectious endocarditis. In the total patient group 43% had aortic insufficiency, 28% had aortic stenosis, and 29% had mixed disease. Results. Operative mortality was 5.2% with a late mortality of 2.6%. The ac tuarial survival was 90.2% at 10 years. Freedom from autograft explantation was 93.2% and freedom from homograft replacement was 98.4%. The endocardit is patients had an operative mortality of 3.8% with 100% cure of the infect ion. Freedom from reinfection on the autograft was 98.1%, and freedom from infection of the pulmonary homograft was 98.1%. The actuarial survival was 86.3%. Conclusions. A specific review of the patients with aortic insufficiency re sulted in a failure of the autograft in 7 patients among a cohort of 41 dur ing the first 5 years of the study. After a change in technique in which th e aortic annulus is narrowed and fixed to a measured size to match the body surface area, we have had no failures in the autograft. Although these res ults are early, we believe that these data support the use of the autograft as an excellent choice for replacement of the aortic valve in infective en docarditis. Finally, the use of the autograft for aortic insufficiency is r easonable with fixation of the aortic annulus so that subsequent dilation d oes not occur. (C) 2001 by The Society of Thoracic Surgeons.