T he Ross procedure involves replace- ment of the diseased aortic valve with the patient’s own pulmonary valve (autograft) and reimplantation of a bi- ological valve (homograft) in the pulmonary position. 1,2 The Ross procedure has poten- tial advantages over conventional surgical techniques of aortic valve replacement (me- chanical or biological prosthesis). The complexity of the Ross procedure and the need for the patient’s consent to a double valve operation are balanced by its benefits in the form of excellent haemody- namics, the potential for permanent repla- cement of the aortic valve, the low risk of endocarditis and the avoidance of lifelong anticoagulation. The Ross procedure is indicated in pa- tients when anticoagulation is contraindicat- ed (e.g. women of reproductive age), in pa- tients with an active life style (e.g. athle- tes), or in patients who refuse to or cannot take anticoagulants (e.g. poor compliance or allergy). The use of the Ross procedure increas- ed during the 1990s as a result of improved surgical techniques (method and cardiople- gia) and the increasing availability of cryop- reserved homografts. In this paper we report our experience from 21 patients who under- went the Ross procedure, performed by a single surgeon at a single hospital. Methods Patients Between December 1998 and January 2004, 21 patients (mean age 42 years, range 16- 160 ñ HJC (Hellenic Journal of Cardiology) Ross Procedure: Medium-Term Results ANTONIS A. PITSIS, TIMOTHEOS G. KELPIS, PETROS S. DARDAS, NIKOLAOS E. MEZILIS, DIMITRIOS D. TSIKADERIS, HARISIOS K. BOUDOULAS Thessaloniki Heart Institute, St. Lucas Hospital, Thessaloniki, Greece Introduction: The Ross procedure is a safe alternative option for aortic valve replacement in selected pa- tients. Here we present the medium-term results of our experience with this procedure. Methods: Between December 1998 and January 2004, 21 patients (16 male, 5 female, mean age 42 years) underwent aortic valve replacement using the Ross operation. Indications for operation were aortic stenosis in 5 patients, aortic regurgitation in 5 patients, aortic stenosis and regurgitation in 9 patients, acute septic en- docarditis of a native aortic valve in 1 patient and of a mechanical aortic valve in 1 patient. The root replace- ment technique was used in 17 patients (81%) and the subcoronary insertion technique in 4 patients (19%). Results: Hospital mortality was 4.7% (1 patient) and late mortality is zero. Mean follow up duration was 4 years (range 1-6 years). On follow up all of the patients were in New York Heart Association class I. One pa- tient developed neo-aortic root dilatation (5.1 cm) with mild neo-aortic valve regurgitation and underwent a modified David I procedure using a Valsalva graft. None of the patients had a gradient of more than 10 mmHg through the pulmonary autograft. Sixteen patients had no aortic insufficiency, while mild aortic regur- gitation developed in three patients. Pulmonary valve regurgitation developed in 11 patients (range 8-75 mmHg) but only one patient (75 mmHg) developed significant asymptomatic stenosis. Conclusions: Our experience with the Ross procedure suggests that aortic root replacement with a pul- monary autograft can be performed safely in adult patients. Pulmonary homograft degeneration requiring re- intervention might be a rare complication. Manuscript received: September 13, 2005; Accepted: January 25, 2006. Address: Antonis A. Pitsis 9 Nimfon St., Panorama 55236 Thessaloniki Greece e-mail: apitsis@otenet.gr Key words: Aortic valve disease, Ross procedure, homograft, autograft. Hellenic J Cardiol 47: 160-163, 2006 Original Research Original Research