TY - JOUR AU - Liebrich, Markus AU - Charitos, Efstratios I. AU - Dingemann, Christoph AU - Roser, Detlef AU - Seeburger, Joerg AU - Hemmer, Wolfgang AU - Voth, Vladimir PY - 2021 TI - The reinforced full-root technique for the Ross operation: surgical considerations and operative insights JF - Annals of Cardiothoracic Surgery; Vol 10, No 4 (July 30, 2021): Ross Procedure Y2 - 2021 KW - N2 - Background: Surgical treatment of young and middle-aged patients suffering from aortic valve disease remains an unresolved issue due to the limited durability of bioprosthetic heart valve replacements and the valve-related morbidity of patients with mechanical valve substitutes. Theoretically, the “living valve” principle of the Ross operation may represent a potentially viable solution to this dilemma. In this paper, we report on the surgical techniques of the Ross procedure and present long-term post-operative outcomes using the reinforced full-root technique. Methods: From 1995 to 2020, a total of 832 consecutive patients (mean age, 43.4±13.7 years; 617 males) underwent a Ross operation using the full-root technique. Patients were prospectively monitored with clinical and echocardiographic follow-up. Total follow-up was 9,046 patients-years and was 92% complete. Mean-follow-up was 10.9±6.9 years (range, 0–24.9 years) Results: Survival at twenty years was 92% (95% CI: 90–94%). Freedom from autograft or right ventricle to pulmonary artery connection reoperation at twenty years was 79% (95% CI: 74–85%). Eighty-nine pulmonary autograft reoperations had to be performed in eighty patients; salvage of the pulmonary autograft could be performed in forty-six of them. Fifty-seven patients required sixty-three reoperations on the right ventricle to pulmonary artery connection. Major cerebral bleeding occurred in one patient and neurological events in seventeen patients, respectively. Conclusions: Over a follow-up interval of up to twenty-five years, the Ross operation with the reinforced full-root technique demonstrated excellent survival in young and middle-aged patients. The rate of pulmonary autograft and right ventricular outflow graft reoperations were low in this patient subset. Therefore, the Ross operation with the reinforced full-root technique represents an enduring and valid treatment option in young and middle-aged patients suffering from aortic valve disease. UR - https://www.annalscts.com/article/view/16835