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Editorial comment
Long-term results of the Ross procedure in adults
Resultados a longo prazo do procedimento Ross nos adultos
José Carlos Areias
Pediatria e Cardiologia Pediátrica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Resultados a longo prazo do procedimento Ross nos adultos"
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    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Ross procedure is an alternative method of correcting aortic valve disease with many advantages over conventional aortic valve replacement&#46; These include physiological hemodynamics&#44; lower thromboembolic risk&#44; freedom from lifelong anticoagulation&#44; and increased long-term survival&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> However&#44; although the Ross procedure is associated with low mortality and better quality of life&#44; its use is limited to relatively few centers&#46; Moreover&#44; many adult Ross patients will require a reintervention at some point&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first question that arises is who are the ideal candidates for the Ross procedure&#44; and the second is which valve is the optimum one for the replacement&#46; The use of a pulmonary autograft to replace the diseased aortic valve in adults&#44; as in the Ross procedure&#44; has not been widely adopted&#44; due to the need for complex perioperative care&#44; among other concerns&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A number of risk factors for autograft failure have been published&#44; including preoperative aortic regurgitation&#44; bicuspid aortic valve&#44; patient age and male gender&#46; Moreover&#44; the current guidelines of the American College of Cardiology&#47;American Heart Association state that in young patients&#44; the Ross procedure should only be considered when anticoagulation is contraindicated&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Several comprehensive papers designed to guide decision-making in aortic valve replacement in adults have been published&#46; They include a recent algorithm to enable cardiologists and surgeons to select patients for the Ross procedure&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1&#44;2</span></a> Two advantages of the Ross procedure are its compatibility with high levels of physical activity and its feasibility in women considering pregnancy&#46; The potential pitfalls are its technical complexity&#44; the potential long-term failure of two valves&#44; and the difficulties of reoperation&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>&#44; Guerreiro et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> publish a long-term assessment of the Ross procedure in adults&#44; focusing on clinical and echocardiographic follow-up at 20 years&#46; Fifty-six patients who had undergone the procedure were analyzed&#46; Indications for surgery were dominant aortic stenosis and isolated aortic regurgitation&#46; Survival was similar to that of the age- and gender-matched general population&#46; A subcoronary approach was mostly used&#44; with good clinical and hemodynamic results&#44; and low rates of reoperation in long-term follow-up&#46; The results were comparable to previously published series&#44; although these had a shorter follow-up&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; the Ross procedure is an alternative method of correcting aortic valve disease that offers several advantages over conventional aortic valve replacement&#46; A combination of aortic regurgitation and bicuspid aortic valve is the main risk factor for late autograft dilatation and dysfunction&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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                          "autores" => array:3 [
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                    0 => array:2 [
                      "titulo" => "Ross procedure in adults for cardiologists and cardiac surgeons&#58; JACC state of the art review"
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                        0 => array:2 [
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                          "autores" => array:3 [
                            0 => "A&#46; Mazime"
                            1 => "I&#46; El-Hamamsy"
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                        "fecha" => "2018"
                        "volumen" => "72"
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                          "autores" => array:3 [
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ISSN: 21742049
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Revista Portuguesa de Cardiologia (English edition)
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