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Title: The Ross procedure using autologous support of the pulmonary autograft: techniques and late results
Epworth Authors: Skillington, Peter
Larobina, Marco
Other Authors: Mokhles, M. Mostafa
Takkenberg, Johanna
O'Keefe, Michael
Wynne, Rochelle
Tatoulis, James
Keywords: Department of Cardiothoracic Surgery, Epworth Hospital, Melbourne, Australia
Pulmonary Autograft
Ross Procedure
Aortic Root Manipulation
Autologous Support
Echocardiographical measurement
Issue Date: Feb-2015
Publisher: The American Association for Thoracic Surgery
Citation: J Thorac Cardiovasc Surg. 2015 Feb;149(2 Suppl):S46-52.
Abstract: OBJECTIVES: It is hypothesized that by performing radical aortic root manipulation and then autologous support for the pulmonary autograft in the Ross procedure, this will maintain aortic root size and should, in turn, lead to the demonstrated low incidence of late aortic regurgitation and need for reoperation on the aortic root and valve. METHODS: Aortic root size was measured echocardiographically both preoperatively and then at second yearly intervals in 322 consecutive patients who underwent a Ross operation between October 1992 and June 2013 with autologous support of the pulmonary autograft root using the patient's own aorta. This technique, a variant of the inclusion cylinder method, has been developed with the aim of minimizing prosthetic materials in the aortic root. RESULTS: Measures to reduce aortic root size included annulus reduction in 201 patients (62.4%) and reduction in aortic sinus or sinotubular junction in 159 patients (49.4%). Maximal aortic root diameter postoperatively at 5, 10, and 15 years was 34.0, 34.6, and 34.7 mm, respectively. Eleven reoperations were required during the study period for progressive aortic regurgitation (none for aortic root enlargement), with freedom from reoperation being 96% at both 15 years and 18 years. Preoperative pure aortic regurgitation, aortic annulus, and sinotubular junction enlargement were risk factors for reoperation. CONCLUSIONS: This inclusion method of pulmonary autograft implantation leads to minimal increases in aortic root size over time, with no reoperations for aortic root dilatation and a low requirement for aortic valve reoperation. The Ross procedure deserves to remain on the surgical menu for aortic valve replacement.
DOI: 10.1016/j.jtcvs.2014.08.068
PubMed URL:
ISSN: 0022-5223
Journal Title: The Journal of Thoracic and Cardiovascular Surgery
Type: Journal Article
Affiliated Organisations: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
Department of Nursing, University of Melbourne, Parkville, Australia.
Department of Surgery, University of Melbourne, Parkville, Australia
Type of Clinical Study or Trial: Descriptive Study
Appears in Collections:Cardiac Sciences

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