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A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
Results of the Ross operation in a pediatric population
Mark G Hazekamp1, Heynric B Grotenhuis, Paul H Schoof
1Department of Cardiothoracic Surgery D6-26, Leiden University Medical Center, 2300 RC Leiden, The Netherlands. m.g.hazekamp@lumc.nl
Insights
The pediatric Ross procedure shows good long-term survival, but autograft dilatation is a concern. Further research is needed to understand the implications of this finding in children.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Cardiac Surgery Outcomes
Background:
- The Ross procedure is a surgical option for pediatric aortic valve disease.
- Congenital aortic valve/left ventricular outflow tract anomalies are common in this population.
- Many patients have a history of prior interventions.
Purpose of the Study:
- To evaluate mid-term clinical and echocardiographic outcomes of the pediatric Ross operation.
- To assess the long-term efficacy and potential complications of the procedure in children.
Main Methods:
- Echo-Doppler follow-up of 53 pediatric Ross procedures (1994-2003).
- Analysis of patient demographics, surgical details, and clinical outcomes.
- Assessment of autograft dimensions, gradients, and insufficiency.
Main Results:
- Actuarial survival and event-free survival at 9 years were 89% and 74%, respectively.
- 9.4% of patients required reoperation for autograft dilatation or leaflet issues.
- 84% had trivial to mild autograft insufficiency; no autograft stenosis was observed.
Conclusions:
- The pediatric Ross procedure is a viable option, but autograft dilatation warrants attention.
- The long-term significance of autograft dilatation in pediatric patients requires further investigation.
Objective:
To analyse the results of the mid-term clinical and echocardiographic follow-up of the pediatric Ross operation.
Methods:
Echo-Doppler follow-up of 53 consecutive pediatric Ross procedures performed between 1994 and 2003. Median age was 9.7 years at time of operation (2 weeks-17.7 years). Six patients were younger than 3 months. Median age at follow-up was 15.6 years. Aortic valve/left ventricular outflow tract (LVOT) anomalies were congenital in 49 (92%). Seventy percent had previous surgery or balloon valvuloplasty. Root replacement was used in all. Thirteen patients (25%) had LVOT enlargement. Mean cross-clamp time was 113 (69-189) minutes.
Results:
Early mortality occurred in 3 patients after emergency surgery following balloon failure (n=1) and extended Ross following interrupted arch/VSD repair (n=2). Late mortality was due to LV fibroelastosis in 2 patients and complicated pulmonary artery stenting in another. RVOT reoperations were required because of late homograft obstruction in 2 patients and because of pulmonary artery stenosis in another. Five patients (9.4%) were reoperated for pulmonary autograft dilatation (n=3) and for leaflet fibrosis or perforation (n=2). Autografts were repaired in two patients, while a mechanical valve was inserted in 3 cases. At 9 years the actuarial survival and event free survival were 89 and 74%, respectively. At last follow-up 90% of autograft diameters indexed to body surface area was above the 90th percentile of normal aortic root diameters. LVOT and RVOT gradients were low and autograft insufficiency was trivial to mild in 84% and mild to moderate in 16%. Autograft stenosis was not noticed.
Conclusions:
The pediatric Ross procedure remains an important tool but autograft dilatation also occurs in the pediatric population. The significance of this finding has yet to be determined.
