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The Ross operation is the only operation which guarantees long-term survival of the aortic valve substitute, and allows it to reproduce some of the extremely sophisticated functions of the normal living aortic valve.1 This has been shown to translate into longer survival and better quality of life in adults.2 The operation was described almost 50 years ago,3 primarily for use in growing children, to avoid anticoagulation and repeated operations. In spite of that, the exact role, timing and techniques of applying this operation for this particular group of patients are still hotly debated.4 It could be argued that application of formal decision theory could almost immediately resolve this dilemma, by constructing a decision tree based on defining outcome of alternative decisions at each node. This however, depends on the availability of accurate statistics from large databases, which simply are not available. Until recently the …