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This study, spanning from February 2003 to December 2022, included patients under 40\u00a0years at the time of the Ross procedure, with MRI follow-ups assessing dimensions at key aortic sites. Among 307 patients, 132 MRIs were analyzed from 76 individuals, revealing that autograft z-scores increase primarily with time post-procedure (Coef. 0.13; 95% CI:0.051\u20130.216; P\u2009=\u20090.002). Additionally, older patients at the time of surgery showed larger ascending aortic dimensions (Coef. 0.13; 95% CI:0.099\u20130.165; P\u2009=\u20090.001). Notably, autograft dilation at the sinus of Valsalva significantly predicted higher reintervention risks (HR 1.57; 95% CI:1.21\u20132.04; P\u2009=\u20090.001). Surgical reinforcement techniques of the autograft, via subcoronary implantation or external support, prevented such dilation (P\u2009&lt;\u20090.001) and mitigated aortic regurgitation. In conclusion, our model predicted autograft dilation over time in patients after Ross procedure, aiding clinicians in making data-driven decisions regarding the optimal timing of the procedure and the selection of the most effective surgical strategy.<\/jats:p>","DOI":"10.1038\/s41598-025-86953-5","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T13:04:57Z","timestamp":1737551097000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Autograft dilation after Ross procedure in children and young adults is mitigated by autograft reinforcement: A retrospective MRI study"],"prefix":"10.1038","volume":"15","author":[{"given":"Raphael","family":"Seiler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Stenzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktoria","family":"Weixler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Muiznieks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"G\u00fcrtner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titus","family":"K\u00fchne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi-Young","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Photiadis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Kelm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Murin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"86953_CR1","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1016\/S0140-6736(67)90794-5","volume":"290","author":"DN Ross","year":"1967","unstructured":"Ross, D. 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