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J Thorac Cardiovasc Surg 2008;136:623-630
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Ross operation: 16-year experience

Ronald C. Elkins, MD*, David M. Thompson, PhD, Mary M. Lane, PhD, C. Craig Elkins, MD, Marvin D. Peyton, MD

Department of Surgery, Section of Thoracic and Cardiovascular Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla

Received for publication April 18, 2005; revisions received October 29, 2007; accepted for publication February 25, 2008.

* Address for reprints: Ronald C. Elkins, MD, Section of Thoracic Surgery, University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190. (Email: ronald-elkins{at}ouhsc.edu).

Objective: We performed a review of a consecutive series of 487 patients undergoing the Ross operation to identify surgical techniques and clinical parameters that affect outcome.

Methods: We performed a prospective review of consecutive patients from August 1986 through June 2002 and follow-up through August 2004. Patient age was 2 days to 62 years (median, 24 years), and 197 patients were less than 18 years of age. The Ross operation was performed as a scalloped subcoronary implant in 26 patients, an inclusion cylinder in 54 patients, root replacement in 392 patients, and root–Konno procedure in 15 patients. Clinical follow-up in 96% and echocardiographic evaluation in 77% were performed within 2 years of closure.

Results: Actuarial survival was 82% ± 6% at 16 years, and hospital mortality was 3.9%. Freedom from autograft failure (autograft reoperation and valve-related death) was 74% ± 5%. Male sex and primary diagnosis of aortic insufficiency (no prior aortic stenosis) were significantly associated with autograft failure by means of multivariate analysis. Freedom from autograft valve replacement was 80% ± 5%. Freedom from endocarditis was 95% ± 2%. One late thromboembolic episode occurred. Freedom from allograft reoperation or reintervention was 82% ± 4%. Freedom from all valve-related events was 63% ± 6%. In children survival was 84% ± 8%, and freedom from autograft valve failure was 83% ± 6%.

Conclusions: The Ross operation provides excellent survival in adults and children willing to accept a risk of reoperation. Male sex and a primary diagnosis of aortic insufficiency had a negative effect on late results.

Abbreviations and Acronyms AGI = autograft valve insufficiency; AI = aortic insufficiency; ALF = allograft valve failure; AS = aortic stenosis; BSA = body surface area; CI = confidence interval; GEE = generalized estimating equation; HR = hazard ratio; VSD = ventricular septal defect




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