What are the limits for the Ross operation?

The Ross operation is physiologically the best approach for aortic valve replacement. At the Hospital de Santa Cruz 22 consecutive pulmonary autograft operations have been performed in patients with a mean age of 49 (range 17-65) years. Six patients had mitral valve disease, two had aortic aneurysms and one had a ventricular septal defect. Subcoronary implantation of the autograft was performed in 20 patients. A partial inclusion aortic root replacement technique was used in one and the aortic root was replaced in another. There were no hospital or late deaths. Two patients required autograft replacement at 3 and 9 months postoperatively because of regurgitation. One of these cases was caused by an abnormality of the pulmonary valve and since then echocardiographic assessments of this valve have been performed routinely and have detected significant pulmonary incompetence in four patients who otherwise would have been operated on using the Ross procedure.