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The Ross procedure in patients aged less than 18 years: the midterm results
Gianluca Brancaccio1, Angelo Polito1, Stiljan Hoxha1
1Department of Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.
Insights
The Ross procedure is a viable option for pediatric aortic valve disease, showing good survival and low autograft failure rates. However, long-term outcomes in adolescents require further consideration.
Area of Science:
- Pediatric Cardiac Surgery
- Aortic Valve Repair and Replacement
- Congenital Heart Disease Management
Background:
- The Ross procedure, utilizing autografts, is a complex surgical technique for aortic valve disease.
- Pediatric patients with aortic stenosis and left ventricular outflow tract obstruction often require specialized surgical interventions.
Purpose of the Study:
- To evaluate the single-center experience and long-term outcomes of the Ross procedure in infants and young children.
- To assess the efficacy and safety of the Ross procedure for managing aortic valve disease in a pediatric population.
Main Methods:
- A retrospective review of 55 children (aged <17 years) who underwent the Ross procedure between November 1993 and March 2012.
- Analysis included patient demographics, indications for surgery (predominantly aortic stenosis), concomitant procedures, and follow-up data.
- Modified Ross-Konno procedures were performed in 49% of patients with left ventricular outflow tract obstruction.
Main Results:
- Overall survival at 10 years was 84.9%, with a hospital mortality rate of 13%, primarily in neonates and infants.
- Freedom from reoperation for autograft failure was 73.7% at 10 years, with 7 patients requiring reoperation for autograft dilatation or insufficiency.
- Freedom from reoperation for right ventricular outflow tract replacement was 56.1% at 10 years.
Conclusions:
- The Ross procedure demonstrates a low rate of autograft failure, making it an attractive option for pediatric aortic valve disease and complex left ventricular outflow tract obstruction.
- While successful in younger children, alternative surgical strategies should be considered for adolescents and young adults due to potential long-term autograft issues.
Objective:
This study reviews a single-center experience with the Ross procedure in infants and young children.
Methods:
From November 1993 to March 2012, 55 children aged less than 17 years underwent a Ross procedure. The patients ranged in age from 2 days to 17 years (median, 5.9 years). Thirteen patients were infants, and 18 patients were preschool children. The predominant indication for the Ross procedure was aortic stenosis. Twenty-seven patients (49%) with left ventricular outflow tract obstruction underwent a modified Ross-Konno procedure. Twenty-five patients (45%) had undergone 40 previous cardiac procedures. Preoperatively, 3 patients showed severe left ventricular dysfunction, with 2 of the patients requiring intubation and inotropic support. Concomitant procedures were performed in 11 patients (20%). Nine patients underwent mitral valve surgery, and 2 patients underwent subaortic membrane resection.
Results:
Patients were followed up for a median of 66 months (range, 3 months to 17 years). Overall survival at 1, 2, 5, and 10 years was 84.9%. Hospital mortality rate was 13% (7/55 patients). All deaths occurred in neonates or infants, except 1 who was aged less than 4 years. Freedom from reoperation for autograft failure was 100% at 1 year, 96.7% at 5 years, and 73.7% at 10 years. During follow-up, 7 patients required a reoperation on the autograft for dilatation and severe aortic insufficiency. Freedom from reoperation for the right ventricular outflow tract replacement was 56.1% at 10 years.
Conclusions:
The low rate of autograft failure demonstrates that the Ross procedure is an attractive option for the management of aortic valve disease and complex left ventricular outflow tract obstruction in the pediatric population. However, alternative options must be considered in adolescents and young adults.
