The ross operation: results of early experience including treatment for endocarditis

The Ross operation has been performed for more than 25 years and itspopularity has increased dramatically in recent years. We developed aninterest in this procedure through a combination of a basic dissatisfactionwith a device that requires life-long anticoagulation and the belief that avital, autologous tissue valve with normal valve morphology andhemodynamics would prove to be superior to the mechanical valve, and thatthese advantages would outweigh the potential drawbacks related to theoperation's technical difficulty and the risk of autograft or homograftdysfunction. From December 1992 to November 1994 40 Ross operations astotal root replacements in a diverse group of patients between 5 and 72years of age (median 32) were performed at Rigshospitalet. Seventeen (43%)of the patients had undergone at least one previous open heart operation.Eleven patients (28%) required surgery because of ongoing or previousendocarditis, and of these, nine had aortic annular destruction andcavity/pseudoaneurysm formation and five had prosthetic valve endocarditis.Three patients (8%) were operated because of mechanical valve dysfunction.One patient was treated for an ascending aortic aneurysm and aorticinsufficiency. The remaining 25 patients were operated because ofcongenital or acquired aortic insufficiency, stenosis, or both. Tenpatients (25%) underwent concomitant procedures. No mortality or seriouscomplications occurred. Morbidity was limited to one case each of totalatrioventricular (A-V) block, sternal pseudarthrosis, minor stroke, anddeep vein thrombosis. Thirty-five patients had no or trivial, two patientsmild, and three patients moderate autograft valve insufficiency during amedian follow-up of 8 months (range 0-23 months). Two patients hadpulmonary stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)