on behalf of the German-Dutch Ross Registry Background-Autograft reinforcement interventions (R) during the Ross procedure are intended to preserve autograft function and improve durability. The aim of this study is to evaluate this hypothesis. Methods and Results-1335 adult patients (mean age:43.5Ϯ12.0 years) underwent a Ross procedure (subcoronary, SC, nϭ637; root replacement, Root, nϭ698). 592 patients received R of the annulus, sinotubular junction, or both. Regular clinical and echocardiographic follow-up was performed (mean:6.09Ϯ3.97, range:0.01 to 19.2 years). Longitudinal assessment of autograft function with time was performed using multilevel modeling techniques. The Root without R (RootϪR) group was associated with a 6ϫ increased reoperation rate compared to Root with R (RootϩR), SC with R (SCϩR), and without R (SC-R; 12.9% versus 2.3% versus 2.5%.versus 2.6%, respectively; PϽ0.001). SC and Root groups had similar rate of aortic regurgitation (AR) development over time. RootϩR patients had no progression of AR, whereas RootϪR had 6 times higher AR development compared to RootϩR. In SC, R had no remarkable effect on the annual AR progression. The SC technique was associated with lower rates of autograft dilatation at all levels of the aortic root compared to the Root techniques. R did not influence autograft dilatation rates in the Root group. Conclusions-For the time period of the study surgical autograft stabilization techniques preserve autograft function and result in significantly lower reoperation rates. The nonreinforced Root was associated with significant adverse outcome. Therefore, surgical stabilization of the autograft is advisable to preserve long-term autograft function, especially in the Root Ross procedure. (Circulation. 2009;120[suppl 1]:S146-S154.)

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on behalf of the German Ross RegistryBackground-Autograft regurgitation and root dilatation after the Ross procedure is of major concern. We reviewed data from the German Ross Registry to document the development of autograft regurgitation and root dilatation with time and also to compare 2 different techniques of autograft implantation. Methods and Results-Between

Although longer follow-up of patients who undergo Ross operation is needed, the present series confirms that the autograft procedure is a valid option to treat aortic valve disease in selected patients. The nonreinforced full root technique and preoperative aortic regurgitation are predictors for autograft failure and warrant further consideration. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00708409.

There is a consistent need for conduit re-intervention following the Ross operation in children. Re-interventions on the autograft are rare within the first decade after surgery. However, the number of autograft re-interventions may increase after the first decade, since longer follow-up time is a risk factor for autograft failure.