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The Ross procedure in children under ten years of age
N Vitale1, T Hornung, G Ciotti
1Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
Insights
The Ross procedure is a safe and effective aortic valve replacement for children under 10. Early results show no autograft dilatation or homograft stenosis, suggesting it
Area of Science:
- Pediatric Cardiac Surgery
- Aortic Valve Replacement
- Cardiovascular Research
Background:
- The Ross procedure's benefits in children under 10 require validation.
- Concerns exist regarding pulmonary autograft dilatation and homograft stenosis.
Purpose of the Study:
- To evaluate the safety and efficacy of the Ross procedure in young children.
- To assess autograft performance and homograft integrity in this pediatric population.
Main Methods:
- Retrospective analysis of 11 children (3 months to 10 years) undergoing aortic root replacement.
- Data collected from January 1996 to January 1999 across two pediatric surgical centers.
Main Results:
- 100% event-free survival with no operative deaths.
- No progressive autograft dilatation or significant aortic regurgitation observed.
- Low homograft peak gradients and satisfactory functional class (NYHA I/II) in all patients.
Conclusions:
- The Ross procedure is a safe and viable option for aortic valve replacement in children.
- Early follow-up indicates satisfactory autograft performance.
- Pulmonary root autograft may be an attractive alternative for pediatric aortic valve disease if dilatation is avoided.
Background And Aims Of The Study:
The potential advantages of the Ross procedure in children under 10 years of age have yet to be validated. Concerns remain regarding progressive dilatation of the pulmonary autograft and potential homograft stenosis. We present our experience in this age population.
Methods:
A retrospective analysis of aortic root replacement using the Ross procedure in 11 young children (nine males, two females; median age 84 months; range 3 months to 10 years) between January 1996 and January 1999 was performed jointly in two pediatric surgical centers.
Results:
There were no operative deaths. Mean hospital stay was 12 +/- 4 days, and mean follow up 14.5 +/- 8 months. The event-free survival (death, reoperation, endocarditis, arrhythmia) was 100%. Currently, nine children are in NYHA functional class I, and two in class II. The autograft and homograft were evaluated by serial echocardiography. There was no sign of progressive dilatation of the autograft. Aortic regurgitation was trivial in four children and mild in seven. No growth of the autograft was noted; this was consistent with minimal somatic growth. Homograft peak gradients remained low during the follow up.
Conclusions:
Although the pulmonary autograft procedure is more complex than other types of aortic valve replacement, it can be safely applied in children. Early follow up indicates satisfactory performance of the autograft. If dilatation will not occur, pulmonary root autograft may be an attractive substitute for diseased aortic valves in children.