Changing indications for the Ross operation.

The first Ross operation in Copenhagen was performed in 1992, and from the beginning of the series, which now numbers 80 patients, the underlying philosophy has been based on our belief that the autograft/Ross operation possesses a number of important and unique advantages compared with other alternatives, particularly for patients with complicated aortic valve disease in which alternative treatments are not satisfactory. The series includes patients of 6 weeks to 71 years of age, many with complicating conditions (endocarditis, 24 patients [native valve, 15; prosthetic valve, 9; advanced 17; active, 15; healed, 9], prosthetic valve dysfunction, 4; small aortic root, 2; ascending aortic aneurysm, 5; ventricular septum defect, 2; mitral valve disease, 7; tricuspid valve disease, 2; rheumatic heart disease, 7; aortic annular dilatation, 2; coronary artery disease, 4; extreme obesity, 1; severely reduced left ventricular function, 7; and previous heart surgery, 28). Mortality is low: hospital mortality, 3 patients (3.75%); late mortality, 1 patient (1.25%). Three patients have required reoperation, however; 1 because of autograft insufficiency and 2 because of pulmonary homograft stenosis, but autograft function is good in 73 (< or = 1+) and acceptable (< or = 2+) in 3 patients, and seems to be stable at follow-up. All in all, the early results are encouraging. We are particularly enthusiastic about the Ross operation for patients with complicated aortic valve pathology such as endocarditis, the small aortic root, combined valvular and subvalvular stenosis, and we believe that the Ross operation may be the best operation for these patients.