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Ross procedure for pediatric aortic valve disease.
Chung-I Chang1, Yu-Chen Ke, Jou-Kou Wang
1Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei.
Journal of the Formosan Medical Association = Taiwan Yi Zhi
|August 11, 2005
Summary
The Ross procedure shows good results for pediatric aortic valve disease. Right ventricle outflow tract reconstruction without extracardiac conduits is a viable option.
Area of Science:
- Pediatric Cardiac Surgery
- Aortic Valve Disease Management
- Surgical Reconstruction Techniques
Background:
- Prosthetic selection for aortic valve replacement in pediatric patients with aortic valve disease remains a complex decision.
- The Ross procedure, while demanding, can yield favorable outcomes in pediatric aortic valve replacement.
- Evaluating different right ventricle outflow tract (RVOT) reconstruction methods is crucial for optimizing Ross procedure results.
Purpose of the Study:
- To assess the outcomes of various right ventricle outflow tract (RVOT) reconstruction techniques in pediatric patients undergoing the Ross procedure for aortic valve disease.
- To compare the efficacy and safety of heterografts, homografts, and non-extracardiac conduits for RVOT reconstruction in this population.
Main Methods:
- A retrospective review of 13 pediatric patients (1 month to 17 years) who underwent the Ross procedure between September 1996 and December 2003.
- Patients had undergone prior aortic valve interventions, including balloon dilation or surgical valvuloplasty.
- Right ventricle outflow tract (RVOT) reconstruction was performed using heterografts (n=3), homografts (n=3), or without extracardiac conduits (n=7).
Main Results:
- One in-hospital death (7.7%) and one late non-cardiac death occurred. One patient developed infective endocarditis.
- No significant neoaortic pressure gradient was observed.
- Severe stenosis developed in 3 patients with heterograft RVOT reconstruction, necessitating reoperation. Patients without extracardiac conduits had no significant pulmonary stenosis but experienced moderate regurgitation (6/7). All 11 survivors were in New York Heart Association functional class I.
Conclusions:
- The Ross procedure demonstrates satisfactory results in pediatric patients with aortic valve disease.
- Right ventricle outflow tract (RVOT) reconstruction without extracardiac conduits presents a feasible and effective alternative to homografts.