Background: The aim of the study was to report on the surgical techniques of the Ross operation
and to evaluate long-term postoperative outcomes using the reinforced full-root technique.
Method: Between 1995 and 2020, a total of 832 patients (mean age, 43.4 ± 13.7 years; 617
males) were treated with a Ross operation using the reinforced full-root technique.
Patients were prospectively monitored clinically and echocardiographically. 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 20 years was 92% (95% CI: 09–94%). Freedom from autograft or right-ventricle
to pulmonary artery connection reoperation at 20 years was 79% (95% CI: 74–85%). Eighty-nine
pulmonary autograft reoperations had to be performed in eighty patients. Autograft
salvage could be performed in forty-six patients (58%). Fifty-seven patients required
63 reoperations on the right ventricle to pulmonary artery connection. Major cerebral
bleeding occurred in one patient and neurological events in seventeen patients, respectively.
Conclusion: The Ross operation with the reinforced full-root technique demonstrated excellent
survival in young and middle-aged patients over a follow-up interval of up to 25 years.
Pulmonary autograft and cryopreserved homograft reintervention/reoperation rate 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.
