{
  "abstract": "Introduction In aortic valve disease, several interventions are available. In young people who are still growing, or considering the risks of long-term anticoagulation, the Ross procedure remains an alternative for aortic valve replacement. This procedure entails the transposition of the patient’s pulmonary valve to the aortic position, with placement of a homograft in the pulmonary position. However, long-term prognosis remains largely unknown.Methods The Swedish national registry of congenital heart disease was searched for adult patients with a history of Ross operation.Results 82 patients (mean age 40.4±15.8 years) were identified, with a mean age at the time of the Ross procedure of 23.6±14.7 years. After a mean follow-up of 16.8±5.5 years, 24.4% of patients underwent a first reoperation involving either the neoaortic valve or the pulmonary homograft, at a mean age of 32.0±13.9 years. The cumulative incidence of reoperation was approximately 15% at 10 years and 30% at 20 years post-Ross procedure. Among the 20 reinterventions, 17 (85.0%) involved the pulmonary valve and 8 the neoaortic valve; five patients underwent procedures on both valves. Two patients (2.3%) died during follow-up.Forty-eight patients in the cohort had undergone primary Ross surgery. This subgroup was older at the time of data extraction (mean age 46.7±15.7 years) compared with those who underwent secondary Ross surgery (mean age 31.3±10.7 years), that is, typically following previous interventions. The secondary Ross group demonstrated better left ventricular function, with ejection fraction >50% in 91.7% of cases, compared with 69.8% in the primary group (p=0.041).Conclusion One in four patients undergoing the Ross procedure requires a reintervention, commonly involving the pulmonary valve. Long-term mortality was low. In selected patients, the Ross procedure remains a viable option; however, late morbidity must be considered. Our findings suggest that secondary Ross surgery is associated with better long-term outcomes, particularly regarding left ventricular function, although the underlying mechanisms remain unclear.",
  "authors": [
    {
      "affiliations": [
        "Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden"
      ],
      "name": "Mostafa Mahmoud"
    },
    {
      "affiliations": [
        "Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden"
      ],
      "name": "Bengt Johansson"
    },
    {
      "affiliations": [
        "Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden"
      ],
      "name": "Daniel Rinnström"
    },
    {
      "affiliations": [
        "Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden"
      ],
      "name": "Camilla Sandberg"
    },
    {
      "affiliations": [
        "Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden"
      ],
      "name": "Christina Christersson"
    },
    {
      "affiliations": [
        "Department of Medicine, Solna, Karolinska Institutet, Stockholm, Stockholm, Sweden"
      ],
      "name": "Peder Sörensson"
    },
    {
      "affiliations": [
        "Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden"
      ],
      "name": "Alexandra Trzebiatowska-Krzynska"
    },
    {
      "affiliations": [
        "Department of Institute of Medicine, Gothenburg university Sahlgrenska Akademin, Gothenburg, Sweden"
      ],
      "name": "Zacharias Mandalenakis"
    },
    {
      "affiliations": [
        "Department of Cardiology, Skåne University Hospital, Lund, Sweden, Lunds Universitet, Lund, Sweden"
      ],
      "name": "Joanna Hlebowicz"
    },
    {
      "affiliations": [
        "Department of Public Health and Clinical Medicine, Umeå Universitet, Umeå, Sweden"
      ],
      "name": "Johan Ljungberg"
    }
  ],
  "title": "Long-term outcome in adults with a previous Ross operation: a cohort study",
  "uid": "2a9b2535-fbbe-5ec6-81de-23e97eb3ac63"
}