The Ross operation: A 12-year experience

Background. The Ross operation, originally introduced as a scalloped subcoronary implant with an 80% survival and 85% freedom from reoperation, has recently been modified to a root replacement which is now the most utilized implant technique. The mid and late results of this operative technique and comparison of intra-aortic implants and root replacement in a single institution are reported. Methods. The records of 328 patients who had a Ross operation at the University of Oklahoma (August 1986 to July 1998) were reviewed to assess operative technique and patient-related factors on survival, autograft valve function, homograft valve function, valve-related complications, and need for reoperation. Results. Operative survival was 95.4% with an actuarial survival of 89% +/- 5% at 8 years. Freedom from replacement of the pulmonary autograft was 94% +/- 3% at 8 years, freedom from reoperation on the pulmonary homograft was 90% +/- 4% at 8 years, and freedom from autograft valve reoperation or dysfunction (3 + autograft valve insufficiency) was 83% +/- 6% at 9 years. The incidence of autograft valve reoperation and late autograft valve dysfunction was decreased by root replacement. Annulus reduction and fixation improved early results in patients with aortic insufficiency and annulus dilatation. Conclusions. Early results have been excellent, as the development of late autograft valve dysfunction or dilatation has been rare. The excellent hemodynamic results with a limited incidence of reoperation and replacement of the autograft Valve justify its continued use. (C) 1999 by The Society of Thoracic Surgeons.