Related Experiment Video
Updated: May 17, 2026
A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
Similarities and differences of the aortic root after arterial switch and ross operation in children
Christiane Pees1, Guenther Laufer, Ina Michel-Behnke
1Pediatric Heart Center, Department of Pediatric Cardiology, University Children's Hospital, Vienna, Austria. christiane.pees@meduniwien.ac.at
Insights
Patients undergoing the Ross procedure or arterial switch for transposition of the great arteries (TGA) show neoaortic root dilation and reduced elasticity. Ross procedure patients exhibit worse outcomes despite shorter systemic pressure exposure.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Cardiac Imaging
Background:
- Pulmonary root dilation and valve regurgitation are common after arterial switch for transposition of the great arteries (TGA) and in Ross procedures.
- The pulmonary valve in the systemic circulation may influence neoaortic root dimensions and elasticity in both groups.
- Understanding these effects is crucial for managing long-term outcomes in pediatric cardiac surgery patients.
Purpose of the Study:
- To prospectively compare neoaortic root dimensions and elasticity in patients after arterial switch for TGA versus the Ross procedure.
- To evaluate the impact of systemic pressure load on the pulmonary autograft in Ross procedure patients.
- To identify factors contributing to neoaortic root changes in these patient populations.
Main Methods:
- Prospective echocardiographic assessment of aortic valve, root, sinotubular junction, and ascending aorta dimensions and elasticity.
- Recruitment of 52 TGA patients, 23 Ross procedure patients, and 48 healthy controls.
- Data analysis stratified by age at investigation and postoperative follow-up duration.
Main Results:
- Both TGA and Ross procedure groups exhibited significantly larger neoaortic root dimensions and stiffer, less distensible tissue compared to healthy controls.
- Ross procedure patients showed more deterioration in dimensions and elasticity despite a shorter duration under systemic pressure load (4.4 years vs. 10.1 years).
- Differences were not clearly attributable to age at surgery, VSD presence in TGA, or pre-operative aortic valve phenotype in Ross patients.
Conclusions:
- Worse neoaortic root dimensions and elasticity in Ross procedure patients are likely linked to inherent differences in pulmonary artery structures and development.
- The pulmonary autograft's performance in the systemic circulation presents distinct challenges compared to its native function.
- Further research into pulmonary artery development and its impact on autograft function is warranted.
Abstract:
Pulmonary root dilation and valve regurgitation if translocated into the aortic position is frequently seen in children with transposition of the great arteries (TGA) after an arterial switch operation, as well as in patients after the Ross procedure. Many mechanisms are thought to be responsible for the progressive dilation. Despite the differences between the 2 groups, the similarity of having the pulmonary valve and its adjacent tissue working in the systemic circulation might have a comparable effect on the neoaortic root dimensions and elasticity. We prospectively recruited 52 patients with TGA, 23 Ross patients, and 48 healthy subjects for echocardiographic assessment of their aortic valve, root, sinutubular junction, and ascending aortic dimensions and elasticity. The data were compared, stratified by patient age at investigation and the duration of follow-up postoperatively. In relation to the healthy subjects, the neoaortic root dimensions were significantly larger and the tissue stiffer and less distensible in those with TGA and those who had undergone the Ross procedure. Although the pulmonary valve of the Ross patients had been under systemic pressure load for a significantly shorter period (4.4 ± 3.6 vs 10.1 ± 5.5 years), the dimensions and elasticity values had deteriorated more. These differences could neither be clearly attributed to the age differences at surgery or to an auxiliary congenital ventricular septal defect in those with TGA or the aortic valve phenotype before the Ross operation. In conclusion, the worse outcome of the neoaortic root dimensions and elasticity in the Ross patients should at least be partly related to the different predefined pulmonary artery structures and the different development of the normal and transposed pulmonary arteries.
