Midterm results of the Ross procedure

The lack of durable bioprosthetic valves and the inherent risks associated with anticoagulation for mechanical valves have led to the continued use of the Ross procedure, particularly in the pediatric population.

We have reviewed our mid-term results retrospectively, following the Ross operation in both pediatric and adult groups.

Over a 11-year period from August 1991 to August 2002, 60 patients underwent the Ross procedure. The median age was 15 years (6-804 months), of which 63% were males and 55% were under the age of 20 years. The main indications were: aortic stenosis in 47 patients; aortic insufficiency in 6 patients; and mixed aortic valve disease in 28 patients. Fifteen patients had previously undergone balloon dilatation of the aortic valve, 4 had open valvotomy and 3 had both valvuloplasty procedures. The pulmonary autograft was implanted as a sub-coronary implant until 1995 (30%) after which time it was implanted using a partial inclusion cylinder technique (70%). There have been no deaths reported in this series. Over a median follow-up period of 59 months (2-122 months), there have been four re-operations for repair of autograft leak, and 2 adult patients have had autograft replacements.

Despite the increased technical complexity, the Ross procedure can be performed safely in both paediatric and adult populations with satisfactory medium term results.