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The Ross operation: initial Israeli experience
1Department of Thoracic and Cardiovascular Surgery, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
Insights
The Ross procedure, using a patient's own pulmonary valve for aortic valve replacement, shows excellent short-term results in young patients. This surgical option offers a promising alternative to artificial valves and homografts.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Valvular Heart Disease
Background:
- Aortic valve replacement in pediatric and young adult patients presents unique challenges.
- The Ross procedure, utilizing autograft pulmonary valves, is a viable option for this demographic.
Purpose of the Study:
- To evaluate the initial short-term outcomes of the Ross procedure in a young patient cohort.
- To assess the efficacy and safety of aortic valve replacement with pulmonary autografts.
Main Methods:
- A retrospective review of 40 patients (8 months to 41 years) who underwent the Ross procedure between January 1996 and June 1999.
- Indications included congenital aortic valve disease, endocarditis, rheumatic fever, and outflow tract obstruction.
- Echocardiography (trans-esophageal and transthoracic) was used for pre-operative, post-bypass, and follow-up assessments.
Main Results:
- No operative or late mortality was observed.
- All patients achieved New York Heart Association functional class I, with no need for medication or complications.
- No progression of autograft insufficiency or left ventricular outflow tract obstruction was noted; minor homograft issues occurred in a few patients.
Conclusions:
- The Ross procedure demonstrates favorable short-term results in young patients.
- It is an effective surgical alternative to prosthetic valves and homografts for aortic valve replacement.
Background:
The need for aortic valve replacement in children and young adults poses a special problem to cardiologists and surgeons. Replacing the sick aortic valve with the patient's pulmonary valve as described by Ross has proven to be a good option in this special age group.
Objective:
To review our initial experience in order to assess the short-term results.
Methods:
From January 1996 to June 1999, 40 patients (age 8 months to 41 years) underwent aortic valve replacement with pulmonary autograft. Indications for surgery were congenital aortic valve disease in 30 patients, bacterial endocarditis in 5, rheumatic fever in 3, and complex left ventricular outflow tract obstruction in 3. Trans-esophageal echocardiography was performed preoperatively and post-bypass in all patients, and transthoracic echocardiography was done prior to discharge and on follow-up.
Results:
There was no preoperative or late mortality. All patients remain in functional class I (New York Heart Association) and are free of complications and medication. None showed progression of autograft insufficiency or LVOT obstruction. Homograft insufficiency in the pulmonary position has progressed from mild to moderate in one patient, and three developed mild homograft stenosis.
Conclusions:
The Ross procedure can be performed with good results in the young population and is considered an elegant surgical alternative to prosthetic values and homografts.
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