Ross and Ross-Konno procedures in infants, children and adolescents: a 13-year experience
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Updated: Jun 24, 2026
A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
Alessandro Piccardo1, Olivier Ghez, Vlad Gariboldi
1Division of Cardiac Surgery, La Timone Children's Hospital, Marseille, France.
Insights
The Ross operation shows excellent long-term survival and low rates of autograft regurgitation in pediatric patients with aortic valve disease. This procedure confirms its status as the preferred surgical choice for young individuals requiring aortic valve repair.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Aortic Valve Disease Management
Background:
- The Ross operation utilizes a pulmonary autograft for aortic valve replacement, offering hemodynamic advantages and growth potential in pediatric patients.
- Irreparable aortic valve disease in children necessitates surgical solutions with favorable long-term outcomes.
Purpose of the Study:
- To evaluate the long-term clinical and echocardiographic results of the Ross operation in pediatric patients.
- To assess the durability and safety of the pulmonary autograft and homograft in the Ross procedure.
Main Methods:
- A cohort of 55 pediatric patients (mean age 10.0 years) underwent either the Ross operation (n=46) or Ross-Konno procedure (n=9) between 1993 and 2006.
- Procedures involved aortic root replacement with a mean cross-clamp time of 132 minutes, followed by a mean follow-up of 5.5 years.
- Echocardiographic assessment included autograft diameter indexed to body surface area and homograft gradients.
Main Results:
- Actuarial patient survival was 93% at 10 years, with only one early and two late deaths.
- No patients developed moderate or severe autograft regurgitation; however, autograft dilatation was common but not correlated with regurgitation.
- Freedom from reoperation for homograft degeneration was 91% at 10 years, with 9% experiencing a mean homograft gradient >= 40 mmHg.
Conclusions:
- The Ross operation demonstrates a low incidence of autograft regurgitation and a low risk of homograft degeneration in pediatric patients.
- Autograft dilatation is a frequent finding but does not compromise autograft function.
- The study reaffirms the Ross operation as the preferred surgical approach for irreparable aortic valve disease in pediatric and young adult populations.
Background And Aim Of The Study:
Due to hemodynamic performance and potential for growth of the pulmonary autograft, the Ross operation is considered to be the surgery of choice for irreparable aortic valve disease in pediatric patients. The study aim was to analyze the long-term clinical and echocardiographic results of the Ross operation.
Methods:
Between February 1993 and July 2006, 55 consecutive patients (mean age 10.0 +/- 6.2 years; range: 3 months to 18 years) underwent eithera Ross operation (n=46) or a Ross-Konno procedure (n=9). The underlying left ventricular outflow tract pathology was mainly congenital (n=47). Among patients, 23 (42%) had undergone a previous aortic valve procedure. Concomitant procedures were performed in 16 patients (29%). The Ross operation was performed as a root replacement in all cases; the mean cross-clamp time was 132 min (range: 100-188 min). The autograft diameter was indexed to the body surface area and compared to normal values. The mean follow up was 5.5 +/- 3.8 years, and was 100% complete.
Results:
There was one early death (2%) and two late deaths (4%). The actuarial patient survival was 93% at 10 years. None of the patients developed moderate or severe autograft regurgitation. All measured maximal root diameters were above the 90th percentile of normal aortic diameter, without correlation to autograft regurgitation. Five patients (9%) had a mean homograft gradient > or = 40 mmHg, and two (4%) were reoperated on. The freedom from reoperation for homograft degeneration was 91% at 10 years.
Conclusion:
Autograft regurgitation after the Ross and Ross-Konno procedures is uncommon, and the risk of homograft degeneration appears low. Autograft dilatation is common but does not correlate with autograft regurgitation. When considering long-term freedom from autograft and homograft degeneration, the results of the present study confirm the Ross operation as the surgery of choice for irreparable aortic valve disease in infants, children and young adults.
