Abstract
The report from Abeln and colleagues1 in this issue of The Annals of Thoracic Surgery is to be commended for its completeness of follow-up and overall outstanding results with survival and freedom from reoperation at 15 years. Furthermore 69% of autograft reoperations were valve-sparing operations. Perhaps the most important facet of this report is that it provides further compelling evidence that the Ross-Yacoub procedure is, to quote Dr David, “the best operation for young and middle age adults with aortic stenosis.”2 The fundamental driving force for this clinical advantage is that the autograft is alive—the leaflets retain the normal aortic valve’s capacity for nitric oxide production (antithrombotic) and contractile and neurohumoral responsiveness (valve performance and durability).
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