Aortic root disease after the Ross procedure.

PURPOSE OF REVIEW: Autograft root pathology is the most common adverse event late after the Ross operation. Therefore, characterization of prevalence, risk factors and natural history of root disease, as well as identification of preventive and therapeutic strategies, is warranted. RECENT FINDINGS: Autograft root pathology affects up to one third of long-term survivors of the Ross operation. Root replacement technique and preoperative aortic aneurysm are recurrent risk factors. Any age group, except for infants, may be affected. Dilatation is often progressive leading to valve regurgitation, true aneurysm, and, rarely, dissection. Primary prevention involves avoidance of root technique, graft repalcement of aneurysmal aorta, or modifications of the root technique. Use of beta-receptor antagonist or angiotensin converting enzyme-inhibitors for secondary prevention is still empirical. Indications to resection of root aneurysm are based on maximum root area indexed to body height. Reintervention prior to appearance of relevant valve insufficiency increases likelihood of pulmonary valve preservation. Definition of functional outcome after autograft valve-sparing procedures needs longer follow-up. SUMMARY: Over a decade after worldwide embracement of the root replacement technique for the Ross procedure, autograft root pathology is emerging as a prevalent complication. Prophylactic and therapuetic strategies are proposed to mitigate the current and future impact of this phenomenon.