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The Ross Procedure in Children: Defining the Optimal Age
Edward Buratto1, Fraser Wallace2, Antonia Schulz2
1Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Vic, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Vic, Australia. Electronic address: http://www.twitter.com/edwardburatto.
Insights
Delaying the Ross procedure in children over 10 years old improves outcomes. This age group shows better survival and reduced need for reoperation, particularly on the pulmonary conduit.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Outcomes Research
- Autograft Procedures
Background:
- The Ross procedure is a complex cardiac surgery.
- Optimal timing for the Ross procedure remains debated.
- Delayed surgery may allow autograft stabilization and larger pulmonary conduit placement.
Purpose of the Study:
- To evaluate the impact of age at the time of the Ross procedure on patient outcomes.
- To compare survival and reoperation rates across different age groups.
Main Methods:
- Retrospective study of 140 patients undergoing the Ross procedure (1995-2018).
- Patients categorized into four age groups: infants, 1-5 years, 5-10 years, and 10-18 years.
- Analysis of early mortality, 15-year survival, and freedom from reoperation.
Main Results:
- Infants had significantly higher early mortality (23.3%) compared to older children (0%).
- 15-year survival was lowest in infants (76.3%) versus older groups (86.7%-94%).
- Freedom from reoperation at 15 years was significantly lower in infants (13.0%) compared to children aged 10-18 years (78.4%).
Conclusions:
- Performing the Ross procedure after age 10 is associated with improved freedom from reoperation.
- This improvement is mainly due to decreased reoperations on the pulmonary conduit.
- Older age at surgery may enhance long-term success of the Ross procedure.
Background:
It has been proposed that delaying the Ross procedure to later in childhood, allowing autograft stabilisation and placement of a larger pulmonary conduit, may improve outcomes. However, the effect of age at the time of Ross procedure on outcomes remains unclear.
Methods:
All patients who underwent the Ross procedure between 1995 and 2018 were included in the study. Patients were divided into four groups: infants, age 1 to 5 years, age 5 to 10 years and age 10 to 18 years.
Results:
A total of 140 patients underwent the Ross procedure in the study period. Early mortality was 23.3% (7/30) for infants compared to 0% for older children (p<0.001). Survival at 15 years was significantly lower in infants (76.3%±9.9%), compared to children aged 1 to 5 years (90.9%±20.1%), 5 to 10 years (94%±13.3%), and 10 to 18 years (86.7%±10.0%), p=0.01. Freedom from autograft reoperation at 15 years was significantly lower in infants (58.4%±16.2%), compared to children aged 1 to 5 years (77.1%±14.9%), 5 to 10 years (84.2%±6.0%) and 10 to 18 years (87.8%±9.0%), p=0.01. Overall freedom from reoperation at 15 years was 13.0%±6.0% for infants, 24.2%±9.0% for children aged 1 to 5 years, 46.7%±15.8% for children aged 5 to 10 years, and 78.4%±10.4%, p<0.001.
Conclusions:
The Ross procedure performed after 10 years of age appears to be associated with improved freedom from reoperation, primarily due to a reduction in reoperation on the pulmonary conduit.
