Ross procedure in infants and toddlers followed into childhood
Ismee A Williams1, Jan M Quaegebeur, Daphne T Hsu
1Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, New York, NY 10032, USA. iib6@columbia.edu
Insights
The Ross procedure is effective for infant aortic stenosis, with no autograft reinterventions needed. Homograft reintervention occurred in 13% within 8 years, and autograft growth stabilized after the first year.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Aortic Valve Repair
Background:
- The Ross procedure is a common treatment for aortic valve disease in children and adults.
- Limited data exist on outcomes for infants undergoing the Ross procedure, including survival, reintervention, and autograft function.
- Infants often present with complex congenital aortic stenosis requiring surgical intervention.
Purpose of the Study:
- To evaluate the outcomes of the Ross procedure in infants with congenital aortic stenosis.
- To assess survival rates, need for reintervention, and autograft growth and function in this pediatric population.
- To provide data on the long-term efficacy and safety of the Ross procedure in very young patients.
Main Methods:
- Retrospective analysis of 27 infants (<18 months) who underwent the Ross procedure for congenital aortic stenosis.
- Detailed review of patient demographics, associated cardiac lesions, and surgical procedures.
- Long-term follow-up including clinical assessment and echocardiography to evaluate autograft and homograft status, reintervention rates, and survival.
Main Results:
- Three early deaths occurred; no late deaths were observed in the median 6.1-year follow-up.
- Freedom from homograft reintervention for dysfunction was 87% at 8 years; freedom from autograft reintervention was 100%.
- Autograft growth was observed, with z scores increasing significantly in the first year and stabilizing thereafter; no significant autograft insufficiency or gradient was noted in most patients.
Conclusions:
- The Ross procedure is an effective treatment for relieving aortic stenosis in infants.
- While homograft reintervention is necessary in a subset of patients, the autograft demonstrates excellent durability and growth potential.
- The findings support the use of the Ross procedure in infants, highlighting favorable autograft development and low reintervention rates for the autograft itself.
Background:
The Ross procedure is commonly used to treat aortic valve disease in pediatric and adult patients. For infants, data are limited regarding survival, reintervention, autograft growth, and function.
Methods And Results:
The Ross procedure was performed in 27 infants <18 months of age (median age 5.7 months). All patients had congenital aortic stenosis (AS); associated lesions included subAS (n=9), supravalvular AS (n=2), coarctation (n=5), and interrupted aortic arch (n=2). Median follow-up was 6.1 years (range 0.2 to 12.9). There were 3 early deaths and no late deaths. Freedom from reintervention for homograft dysfunction was 87% at 8 years; freedom from autograft reintervention was 100%. Follow-up echocardiograms were available in 17 patients. Estimated peak autograft gradient was 55 mm Hg in one patient and <10 mm Hg in 16. Mild autograft insufficiency was seen in 4 patients; 13 had none. Autograft diameter was measured early postoperatively and at latest follow-up. The mean z score increased from 0.63 to 3.2 (P<0.01) at the annulus and from 0.26 to 2.2 (P<0.01) at the sinus. In a subgroup, the mean autograft z score increased significantly from the postoperative period to 1 year for both the annulus (0.72 to 3.2, P<0.01) and the sinus (0.26 to 2.2, P<0.01), but remained unchanged thereafter.
Conclusions:
The Ross procedure effectively relieves AS in infants. Homograft reintervention occurred in 13% within 8 years. No patient developed significant autograft insufficiency or required autograft reintervention during the follow-up period. Dilatation of the autograft occurred during the first year after surgery and stabilized thereafter.
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