[Ross operation: attractive in theory but, is it superior in daily practice?].

Rev Esp Cardiol 2004;57(1):7-11 7 Despite continuous technological advances, we have yet to develop the perfect means of replacing human heart valves. In the case of the aortic valve, there can be no doubt that the best option available is replacement by another human valve. Pulmonary autograft (the Ross operation) ensures hemodynamic performance very similar to that of the native aortic valve and freedom from anticoagulation. Moreover, the autograft will grow, is more resistant to infection than prosthetic valves and does not cause hemolysis. In theory, all of these advantages make the Ross operation ideal for aortic valve replacement in children, adolescents and young adults. However, the procedure involves implanting a cryopreserved pulmonary homograft to reconstruct the pulmonary outflow tract and is technically much more complex than conventional aortic valve replacement. This complexity is the principal reason few Ross operations are performed in Spain. The Spanish National Register records just 40 Ross operations a year,1 which means that of the over 3000 patients operated yearly for single aortic valve disease only slightly more than 1% benefit from pulmonary autograft. Today, the Ross operation can be accomplished with very low mortality (1%-3%) as should be the case with a procedure for patients who are usually young and who present no comorbidity. The Spanish National Register reports 2.4% early mortality among 169 patients at 15 centers.1 This figure concurs with 2.5% early mortality among more than 2500 patients recorded in the International Registry.2 In spite of the technical complexity of the procedure, the incidence of perioperative complications is equally low. ED I TO R I A L S