{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:22:26Z","timestamp":1792452146014,"version":"4.5.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to evaluate the impact of different autograft support techniques during the Ross procedure on long-term outcomes in adolescents and young adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients (\u226512 years) who underwent a Ross procedure between 01\/1996 and 10\/2024 were included. According to autograft support technique, they were divided into 3 groups: No support, Annular support, and Full support (autograft placed inside a straight Dacron graft). Survival was estimated using the Kaplan-Meier method. Cumulative incidence of autograft regurgitation \u2265moderate and autograft (+\/- valve-sparing) root replacement were analysed using the Gray subdistribution method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 131 patients included (median age 17.2 years [IQR: 14.5-24.0]), 76 (58%) had No support, 43 (33%) Full support, and 12 (9%) Annular support. Patients in group No support were significantly younger (P\u2009&amp;lt;\u2009.01) and had smaller native aortic annulus (24 mm vs 26 mm, P\u2009&amp;lt;\u2009.05). Postoperative complications (P\u2009=\u2009.40) and early mortality (P\u2009=\u20091.0) were similar across groups. Median follow-up was 5.7 years (IQR: 2.1-11.8), and 10-year survival was 99%. While cumulative incidence of reoperation was similar between the 3 groups at 10 years (5.6% vs 0% vs 10.1%, P\u2009=\u2009.80), patients with Full support experienced a significantly higher rate of autograft regurgitation \u2265moderate (32.3% vs 13.3% vs 11.1%, P\u2009=\u2009.03).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-term survival after the Ross procedure was excellent in adolescents and young adults. Full support is associated to autograft valve dysfunction at 10 years, while annular support gave more stable autograft outcomes. Further studies are needed to determine whether this reflects a technical learning curve or a reproducible pattern.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezag019","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T12:44:42Z","timestamp":1767789882000},"source":"Crossref","is-referenced-by-count":6,"title":["Fully Supported Ross Procedure is Associated With Neo-Aortic Regurgitation in Adolescents and Young Adults"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5385-673X","authenticated-orcid":false,"given":"Bastien","family":"Provost","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital for Sick Children , M5G2G3 Toronto,","place":["Canada"]},{"name":"Department of Congenital Heart Diseases, Reference Center for Complex Congenital Cardiac Disease M3C, Marie Lannelongue Hospital , 92350 Le Plessis Robinson,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0153-0364","authenticated-orcid":false,"given":"Viktoria","family":"Weixler","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital for Sick Children , M5G2G3 Toronto,","place":["Canada"]},{"name":"Department of Congenital Heart Surgery\u2014Pediatric Heart Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuelle","family":"Fournier","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Diseases, Reference Center for Complex Congenital Cardiac Disease M3C, Marie Lannelongue Hospital , 92350 Le Plessis Robinson,","place":["France"]},{"name":"Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children , M5G2G3 Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2798-3831","authenticated-orcid":false,"given":"Alison","family":"Howell","sequence":"additional","affiliation":[{"name":"Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children , M5G2G3 Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Ho","sequence":"additional","affiliation":[{"name":"Ted Rogers Computational Program, Peter Munk Cardiac Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, University Health Network , M5G2N2 Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Runeckles","sequence":"additional","affiliation":[{"name":"Ted Rogers Computational Program, Peter Munk Cardiac Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, University Health Network , M5G2N2 Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mimi X","family":"Deng","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital for Sick Children , M5G2G3 Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Vanderlaan","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital for Sick Children , M5G2G3 Toronto,","place":["Canada"]},{"name":"Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto , M5G2N2 Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9716-8197","authenticated-orcid":false,"given":"Christoph","family":"Haller","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital for Sick Children , M5G2G3 Toronto,","place":["Canada"]},{"name":"Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto , M5G2N2 Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Alonso-Gonzalez","sequence":"additional","affiliation":[{"name":"Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, University of Toronto , M5G2N2 Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Barron","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital for Sick Children , M5G2G3 Toronto,","place":["Canada"]},{"name":"Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto , M5G2N2 Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6373-0532","authenticated-orcid":false,"given":"Osami","family":"Honjo","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital for Sick Children , M5G2G3 Toronto,","place":["Canada"]},{"name":"Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto , M5G2N2 Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"2026021902165959300_ezag019-B1","doi-asserted-by":"publisher","first-page":"2858","DOI":"10.1016\/j.jacc.2016.04.021","article-title":"Aortic valve replacement and the Ross operation in children and young adults","volume":"67","author":"Sharabiani","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2026021902165959300_ezag019-B2","doi-asserted-by":"publisher","first-page":"1993","DOI":"10.1093\/eurheartj\/ehl550","article-title":"The Ross operation: a Trojan horse?","volume":"28","author":"Klieverik","year":"2007","journal-title":"Eur Heart J"},{"key":"2026021902165959300_ezag019-B3","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1016\/j.jtcvs.2023.06.012","article-title":"Influence of preoperative aortic regurgitation on long-term autograft durability and dilatation in children and adolescents undergoing the Ross procedure","volume":"167","author":"Bouhout","year":"2024","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026021902165959300_ezag019-B4","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.athoracsur.2020.06.027","article-title":"The pulmonary autograft after the Ross operation: results of 25-year follow-up in a pediatric cohort","volume":"111","author":"Bov\u00e9","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"2026021902165959300_ezag019-B5","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.xjtc.2022.11.016","article-title":"Outcomes after the Ross procedure with pulmonary autograft reinforcement by reimplantation","volume":"17","author":"Guirgis","year":"2023","journal-title":"JTCVS Tech"},{"key":"2026021902165959300_ezag019-B6","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1053\/j.pcsu.2005.01.022","article-title":"Modification to the Ross procedure to prevent autograft dilatation","volume":"8","author":"Slater","year":"2005","journal-title":"Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu"},{"key":"2026021902165959300_ezag019-B7","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaf102","article-title":"Optimized outcome of the Ross procedure in children: single-centre experience","volume":"67","author":"Murin","year":"2025","journal-title":"EJCTS"},{"key":"2026021902165959300_ezag019-B8","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/j.xjon.2025.02.012","article-title":"Surgical outcomes of the reinforced Ross procedure in the pediatric population","volume":"24","author":"Bojko","year":"2025","journal-title":"JTCVS Open"},{"key":"2026021902165959300_ezag019-B9","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.athoracsur.2022.05.066","article-title":"The supported vs unsupported Ross in pediatric patients: neoaortic root and ventricular function","volume":"115","author":"Sow","year":"2023","journal-title":"Ann Thorac Surg"},{"key":"2026021902165959300_ezag019-B10","first-page":"1310","article-title":"Optimal timing of Ross operation in children: a moving target?","volume":"168","author":"Ie","year":"2024","journal-title":"JTCVS"},{"key":"2026021902165959300_ezag019-B11","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1016\/j.jtcvs.2024.01.022","article-title":"Long-term autograft dilation and durability after the Ross procedure are similar in infants, children, and adolescents with primary aortic stenosis","volume":"168","author":"Nguyen","year":"2024","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026021902165959300_ezag019-B12","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1001\/jamacardio.2018.2946","article-title":"Ross procedure vs mechanical aortic valve replacement in adults: a systematic review and meta-analysis","volume":"3","author":"Mazine","year":"2018","journal-title":"JAMA Cardiol"},{"key":"2026021902165959300_ezag019-B13","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1016\/j.athoracsur.2019.10.093","article-title":"More than 25 years of experience with the Ross procedure in children: a single-center experience","volume":"110","author":"Martin","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2026021902165959300_ezag019-B14","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1016\/j.jtcvs.2023.04.013","article-title":"Reintervention after valve-sparing aortic root replacement: a comprehensive analysis of 781 David V procedures","volume":"167","author":"Singh","year":"2024","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026021902165959300_ezag019-B15","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1093\/icvts\/ivx431","article-title":"Novel insights by 4D flow imaging on aortic flow physiology after valve-sparing root replacement with or without neosinuses","volume":"26","author":"Galea","year":"2018","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2026021902165959300_ezag019-B16","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.jtcvs.2009.09.053","article-title":"When is the Ross operation a good option to treat aortic valve disease?","volume":"139","author":"David","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026021902165959300_ezag019-B17","doi-asserted-by":"publisher","first-page":"S0022522325009754","DOI":"10.1016\/j.jtcvs.2025.10.042","article-title":"Aortic remodeling and pulmonary autograft performance over two decades after the Ross procedure in the pediatric and young adult population","author":"Salem","year":"2025","journal-title":"JTCVS"},{"key":"2026021902165959300_ezag019-B18","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1016\/j.jacc.2020.07.058","article-title":"Ross procedures in children with previous aortic valve surgery","volume":"76","author":"Buratto","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026021902165959300_ezag019-B19","doi-asserted-by":"publisher","first-page":"2086","DOI":"10.1016\/j.athoracsur.2015.02.068","article-title":"Long-term survival and reintervention after the Ross procedure across the pediatric age spectrum","volume":"99","author":"Nelson","year":"2015","journal-title":"Ann Thorac Surg"},{"key":"2026021902165959300_ezag019-B20","first-page":"1033","article-title":"Initial balloon versus surgical valvuloplasty in children with isolated congenital aortic stenosis: impact on timing of aortic valve replacement","volume":"169","author":"Murphy","year":"2024","journal-title":"JTCVS"},{"key":"2026021902165959300_ezag019-B21","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.xjon.2025.09.043","article-title":"Thirty years of experience with full-root Ross procedure in the pediatric population\u2014timing matters","volume":"28","author":"Weixler","year":"2025","journal-title":"JTCVS Open"},{"key":"2026021902165959300_ezag019-B22","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.jtcvs.2018.06.037","article-title":"Late results of the Ross procedure","volume":"157","author":"David","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026021902165959300_ezag019-B23","first-page":"1017","article-title":"Twenty-five years of the Ross operation in adults: the inclusion technique keeps up the expectations","volume":"170","author":"Caldaroni","year":"2025","journal-title":"JTCVS"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezag019\/66313395\/ezag019.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/2\/ezag019\/66313395\/ezag019.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/2\/ezag019\/66313395\/ezag019.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T07:17:04Z","timestamp":1771485424000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezag019\/8417622"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,8]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2,5]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezag019","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2026,1,8]]},"article-number":"ezag019"}}