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Ann Thorac Surg 2004;78:1489-1495
© 2004 The Society of Thoracic Surgeons


Review

The Ross II Procedure: Pulmonary Autograft in the Mitral Position

Thanos Athanasiou, MD, PhDa,*, Ashok Cherian, MDa, Donald Ross, FRCS

a Department of Robotic and Minimally Invasive Cardiothoracic Surgery, St. Mary's Hospital, London, United Kingdom

* Address reprint requests to Dr Athanasiou, Robotic and Minimally Invasive Cardiothoracic Surgery, St. Mary's Hospital, 70 St. Olaf's Rd, Fulham, London SW6 7DN, UK
tathan5253{at}aol.com

The surgical management of mitral valve disease in women of childbearing age, young patients, and children with congenital mitral valve defects is made difficult by the prospect of lifelong anticoagulation. We suggest the use of a pulmonary autograft in the mitral position (Ross II procedure) as an alternative surgical technique. We present a review of the literature, historical perspectives, indications, selection criteria, and surgical technique for the Ross II procedure. Our literature search identified 14 studies that reported results from the Ross II operation. Performed in 103 patients, the overall in-hospital mortality was 7 (6.7%), with a late mortality of 10 (9%). Although further research is needed, current evidence suggests the Ross II operation is a valuable alternative in low-risk young patients where valve durability and the complication rate from other procedures is unsatisfactory and anticoagulation not ideal.




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