Expanding indications for the Ross operation

During the past 2.5 years, 50 Ross operations have been performed at Rigshospitalet in Copenhagen in a broad range of patients with aortic valve disease including children and adults from 6 weeks to 71 years of age. Many patients had complicating conditions including endocarditis (n = 13, eight native, five prosthetic valve), prosthetic valve dysfunction (n = 4), subvalvular obstruction (n = 3) treated by septal myectomy (n = 1) or modified Konno operation (n = 2), ascending aortic aneurysm (n = 2), ventricular septum defect (n = 1), mitral valve disease (n = 6), rheumatic heart disease (n = 4), coronary artery disease (n = 1), and extreme obesity (n = 1). All operations were performed as free-standing total aortic root replacements. The results have been encouraging with low mortality (2%) and no major morbidity. One patient has been reoperated because of autograft insufficiency due to left coronary cusp prolapse and two additional patients have grade 2 autograft insufficiency and are being followed closely. Two patients have developed early pulmonary homograft stenosis, which has required pulmonary homograft replacement. Despite these problems, we are enthusiastic about this operation and believe it may emerge as operation of choice for most patients under 60-65 years of age with aortic valve disease and for patients with prosthetic or advanced native aortic valve endocarditis. With increasing frequency, our choice has been to proceed with a Ross operation, and currently, our only absolute contraindication is Marfan's syndrome. Based on reported recurrent disease in patients with rheumatic valve disease, the autograft should be used with caution for this indication.(ABSTRACT TRUNCATED AT 250 WORDS)