Current outcomes of Ross operation for pediatric and adolescent patients

The management of aortic valve disease in children and young adults is often a controversial and complex problem. The Ross operation has become an important option for aortic valve replacement in patients with both congenital and acquired disease of the left ventricular outflow tract (LVOT). The acceptance of this procedure has been slow because of the technical demands of the operation and the inherent need for reconstruction of the right ventricular out-flow tract (RVOT), thereby placing two valves at risk. Although more than three decades have passed since the Ross operation was first described, it is only during the past 10 years that it has been increasingly considered for pediatric patients with a wide spectrum of congenital abnormalities of the LVOT. The advantages of the autograft valve include growth potential, optimal hemodynamic performance, and freedom from anticoagulation and hemolysis. However, concerns regarding potential dilatation of the autograft, reoperation for autograft dysfunction, and replacement of RVOT conduits persist. Further, doubts have been expressed by others regarding the indications for the Ross operation in patients with a bicuspid aortic valve and with aortic valve insufficiency. This review evaluates existing evidence on the safety and efficacy of Ross procedure for pediatric and adolescent patients.