273LONG-TERM RESULTS (18 YEARS) OF THE ROSS OPERATION: A SINGLE-INSTITUTIONAL EXPERIENCE

Objectives: To evaluate the long-term results of the Ross operation using the root replacement technique. Methods: Between May 1995 and March 2013, 416 patients with a mean age of 30 ± 12 years were submitted to a Ross operation. The most common aetiologies were bicuspid aortic valve (47%) and rheumatic disease (34%). Fifty-one patients had concomitant procedures, most frequently mitral valve repair (n = 41). Mean follow-up was 8.1 years (min = 0.1, max = 18) and was 96.6% complete. Results: Early mortality was 2.6% (11/416). There were 16 late deaths with actuarial late survival of 87% at 15 years, which closely resembles that of an age- and sex-matched normal population. Freedom from thromboembolism and endocarditis at 15 years was 97% and 98% respectively. Twenty-one patients needed a reoperation on the pulmonary autograft, and 10 of them retained their original autograft. Freedom from pulmonary autograft reoperation was 90% at 15 years. An additional 14 patients had replacement of the pulmonary allograft with a freedom from reoperation on the right side of 93% at 15 years. Freedom from any type of reoperation was 81% at 15 years. Mortality during reoperations was 0%. Conclusions: The Ross operation was associated with excellent long-term survival. The incidence of 20% of reoperations at 15 years is acceptable, and can be carried with low mortality. Proper selection of patients and the use of decellularized allografts for the right ventricular outflow tract can diminish even further the necessity of reinterventions. We still consider the Ross operation the procedure of choice for many young patients with aortic valve disease.