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Updated: Aug 20, 2026
A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
Growth of pulmonary autograft after Ross operation in pediatric patients
1Department of Pediatric Cardiothoracic Surgery, Alder Hey Hospital, Liverpool L12 2AP, UK. drrajashahzad@hotmail.com
Insights
The Ross procedure offers excellent durability for pediatric aortic valve disease, showing no re-operations needed in a 7-year follow-up. This pulmonary autograft technique supports patient growth and maintains good valve function.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- The Ross procedure is increasingly used for pediatric aortic valve disease.
- Concerns exist regarding the long-term durability of the pulmonary autograft.
Purpose of the Study:
- To evaluate the durability and clinical outcomes of the Ross procedure in pediatric patients.
- To assess autograft growth and hemodynamic function over time.
Main Methods:
- Retrospective analysis of 32 pediatric patients undergoing the Ross procedure (1996-2003).
- Utilized root replacement technique with pulmonary autograft.
- Clinical and echocardiographic follow-up up to 7 years.
Main Results:
- No perioperative deaths; 7-year actuarial survival was 96%.
- 100% freedom from re-operation for autograft dysfunction.
- Autograft annulus and sinus showed proportional growth with body surface area.
- Stable hemodynamics observed during long-term follow-up.
Conclusions:
- The Ross procedure demonstrates excellent safety and durability in pediatric patients.
- Pulmonary autograft offers ideal aortic valve replacement with growth potential.
- This technique provides excellent late valve function and low re-operation rates.
Abstract:
The Ross procedure is being used increasingly to treat aortic valve disease in pediatric patients; however, there is an ongoing dispute about the durability of the autograft. From November 1996 to September 2003, 32 pediatric patients (mean age, 11 +/- 4.5 years) underwent the Ross procedure for various aortic valve diseases, using the root replacement technique. Clinical and echocardiographic follow-up was performed early (within 30 days), at 3 to 6 months, and yearly after surgery. There were no perioperative deaths. The patients were followed-up for up to 7 years with a median interval of 36 months. Actuarial survival at 7 years was 96% +/- 3% and there was 100% freedom from re-operation for autograft valve dysfunction or any other cause. The autograft annulus and sinus increased significantly in size during follow-up and the increase in size paralleled the increase in body surface area, with no evidence of disproportional dilatation. The hemodynamics at the latest follow-up were also similar to those at the time of discharge after surgery. Pulmonary autograft replacement of the aortic valve appears to be the ideal solution in pediatric patients, because of relatively low operative risk, excellent late valve function, and real potential for growth.
