Objectives This study was designed to determine echocardiographic follow-up results of the Ross procedure in older adult patients with aortic valve disease. Background The excellent long-term results of the Ross procedure from several institutions have indicated that the pulmonary autograft may be the best available substitute for the diseased aortic valve in children and adolescents. The advantages of this operation include optimal hemodynamics and elimination of thromboembolic complications. These features may benefit older adult patients as well. Methods We reviewed data from 49 consecutive patients who had a Ross procedure between 1991 and 1996. Preoperative and postoperative Doppler echocardiographic studies were available for 44 patients (22 men, 22 women; mean [±SD] age 36 ± 14 years) who were grouped into <40 (n = 25) and ≥40 years old (n = 19). Measurements included left ventricular diastolic volume (LVDV), mass, and ejection fraction (EF); a peak pressure gradient across autograft in the aortic position and homograft in the pulmonary position; and valvular regurgitation. Results The mean length of echocardiographic follow-up was 36 ± 16 months. Postoperatively, there was a reduction in LVDV and left ventricular mass in both age groups: 153 ± 99 mL to 111 ± 72 mL (P = .015) and 210 ± 93 g to 152 ± 54 g (P = .002) for younger patients, 174 ± 115 mL to 126 ± 43 mL (P = .17) and 233 ± 71 g to 215 ± 65 g (P = .19) for older patients. No significant change in EF was noted in the younger age group. However, in the older age group a significant decrease to EF <25% was found in 2 patients 1 year after surgery. Moderate autograft regurgitation was also detected in 2 patients: 1 in each age group. Pressure gradients across the autograft remained within the normal range in both age groups. Two younger patients had severe homograft stenosis with peak gradients of 100 and 62 mm Hg. The older patients did not demonstrate homograft dysfunction. Conclusions The Ross procedure can be performed in selected older adults with aortic valve disease and provides durable valves in both aortic and pulmonic positions for at least 3 years after surgery but may result in less favorable left ventricular remodeling compared with that in the younger patients. Further follow-up will be necessary to determine the long-term outcome of the Ross procedure in this older adult patient population. (Am Heart J 2001;142:331-5.)