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Is the ross procedure a suitable choice for aortic valve replacement in children with rheumatic aortic valve disease?

Bahaaldin Alsoufi1, Cedric Manlhiot, Bahaa Fadel

  • 1King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

World Journal for Pediatric & Congenital Heart Surgery
|June 28, 2013
PubMed

Insights

The Ross procedure offers excellent survival for children with rheumatic fever, but aortic regurgitation necessitates frequent autograft reoperation. Improved patient selection and surgical techniques can reduce reoperation rates.

Area of Science:

  • Pediatric Cardiac Surgery
  • Aortic Valve Replacement
  • Rheumatic Heart Disease

Background:

  • The Ross procedure is a preferred aortic valve replacement in pediatric patients.
  • Concerns exist regarding late autograft reoperation due to dilatation and regurgitation after the Ross procedure.
  • Suitability of the Ross procedure in children with rheumatic fever requires investigation.

Purpose of the Study:

  • To evaluate the long-term outcomes of the Ross procedure in children with rheumatic fever.
  • To determine the incidence and risk factors for autograft reoperation and death.
  • To assess freedom from aortic regurgitation and need for homograft or any cardiac reoperation.

Main Methods:

  • Retrospective review of medical records for 104 children with rheumatic fever who underwent the Ross procedure (1991-2004).
  • Application of competing risks methodology to analyze time-related prevalence of reoperation and death.
  • Identification of associated risk factors for adverse outcomes.

Main Results:

  • Ten-year survival was excellent (1% mortality), but 32% required autograft reoperation.
  • Freedom from moderate or severe aortic regurgitation at 10 years was 63%.
  • Freedom from autograft reoperation was lower for regurgitation (65%) than stenosis (90%); earlier surgery year and lack of annular stabilization were risk factors.

Conclusions:

  • The Ross procedure in children with rheumatic fever demonstrates excellent survival but is challenged by significant aortic regurgitation and high rates of autograft reoperation.
  • Preoperative regurgitation, concomitant surgery, and earlier surgical era are identified risk factors for autograft reoperation.
  • Enhanced patient selection and refined surgical techniques, including root and sinotubular stabilization, are crucial for improving long-term outcomes and reducing reoperation rates.
Abstract

Keywords:
Ross procedureaortic regurgitationaortic valve replacementrheumatic fever

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