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Objective:To evaluate the late outcomes in a consecutive series of 487 Ross operation patients at one institution.
Methods:Prospective review of operative patients from August 1986 thru June 2002 was completed in Aug. 2004. Age 2 days to 62 years(median-24 yrs), 197 patients were age <18 years. Follow-up was 98% complete within 4yrs and 78% within 2yrs. Median follow-up was 5.3 yrs.
Results:Survival was 80%±9% at 16 yrs(operative mortality was 3.9%, 19/487). Freedom from autograft valve degeneration(re-operation or severe insufficiency [non-endocarditis] and valve related death) in 464 patients(3 abnormal pulmonary valve and 1 Lupus erythematosis excluded) was 81%±6% at 16 yrs. Freedom from autograft degeneration for root replacements was 87%±5% vs. intra-aortic implants 82%±6% at 13yrs(p=.06), and for primary indication of aortic stenosis was 95%±2% vs. aortic insufficiency 53%±14% at 13 yrs(p=.002). Aortic valve morphology at operation had no effect on freedom from autograft degeneration. Freedom from endocarditis was 94%±2% at 16yrs. There were no late post-operative thromboembolic or bleeding events in this patient series. Freedom from allograft reoperation or re-intervention was 83%±4% at 16 yrs. Freedom from allograft degeneration(reoperation, severe pulmonary insufficiency, peak gradient of 50 mmHg or more) was 73%±5% at 16 yrs. Freedom from all valve related events was 63%±6% at 16 years. In children, survival was 97%±2% at 13 yrs, freedom from autograft degeneration was 83%±8% at 16 yrs and from valve related events was 67%±9% at 16 yrs.
Conclusions: The Ross operation provides excellent survival in adults and children willing to accept a risk of reoperation; there is a very low risk of other valve related cardiac events. Patient age and pre-operative valve morphology did not affect outcome. Aortic insufficiency as the primary hemodynamic lesion had a negative impact on late results.

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