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Updated: Oct 23, 2025
A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
The Ross procedure in children: a systematic review
Morgan K Moroi1, Emile A Bacha1, David M Kalfa1
1Section of Congenital and Pediatric Cardiothoracic Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Morgan Stanley Children's Hospital, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
The Ross procedure offers a durable aortic valve replacement for pediatric patients, demonstrating favorable survival and excellent hemodynamics without anticoagulation. Further multi-institutional studies are needed to solidify its use in this population.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Valvular Heart Disease
Background:
- The Ross procedure involves using the patient's own pulmonary valve for aortic valve replacement (AVR) and reconstructing the right ventricular outflow tract (RVOT) with a homograft.
- This technique offers advantages such as excellent hemodynamic function, potential for growth, and avoidance of anticoagulation in pediatric patients.
- However, it is technically challenging and carries the risk of developing complications in both the aortic and pulmonary positions.
Purpose of the Study:
- To systematically review the outcomes of pediatric patients who underwent the Ross procedure.
- To evaluate long-term results including mortality, reoperation rates, and complications associated with the procedure.
Main Methods:
- An extensive electronic search was conducted to identify studies reporting on pediatric patients (under 21 years) undergoing the Ross procedure.
- Key outcomes assessed included early and late mortality, sudden death, reoperations for autograft or RVOT failure, thromboembolic events, bleeding, and endocarditis.
Main Results:
- The review included 30 studies encompassing 3,156 pediatric patients with a median age of 9.5 years and 5.7 years of follow-up.
- Early mortality rates ranged from 0.0% to 17.0%, with higher rates in neonates. Late mortality was low (0.04-1.83%/year).
- Reoperation rates for pulmonary autograft failure were 0.37-2.81%/year, and for RVOT reconstruction failure were 0.34-4.76%/year. Other complications occurred at low annual rates.
Conclusions:
- The Ross operation is a durable AVR option for pediatric patients, associated with favorable survival, excellent hemodynamics, growth potential, and reduced complication risk.
- The avoidance of anticoagulation is a significant benefit of this procedure in children.
- Larger, multi-institutional pediatric registries are recommended to gather more robust evidence supporting the Ross procedure.
