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Published on: April 1, 2022
Surgical outcomes of the reinforced Ross procedure in the pediatric population
Markian M Bojko1, Neelesh Bagrodia1, Luke Wiggins1
1Division of Cardiac Surgery, Department of Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, Calif.
Insights
External reinforcement of the Ross procedure using Dacron grafts is safe and effective in pediatric patients. This technique shows acceptable outcomes for valve function, survival, and reintervention rates in children.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- External reinforcement of the Ross autograft is established in adults but less studied in pediatric populations.
- Indications for external reinforcement in pediatric patients are not well-defined.
Purpose of the Study:
- To evaluate the institutional experience with external Dacron graft reinforcement of the Ross autograft in pediatric patients.
- To analyze the outcomes, including hemodynamics, survival, and reintervention rates.
Main Methods:
- A retrospective analysis of 43 pediatric patients (≤18 years) who underwent the Ross procedure with external Dacron graft reinforcement between 2008 and 2023.
- Collected data included baseline characteristics, echocardiographic measurements, and postoperative outcomes.
- Follow-up duration varied, with medians of 2.01 years for younger children and 1.31 years for adolescents.
Main Results:
- The study included patients aged 5-18 years, with a median age of 14 years. Most patients (39/43) had aortic insufficiency or mixed valve disease.
- Operative mortality was 2.3% (1/43), with 12% (5/43) requiring unplanned reoperations postoperatively.
- One-month postprocedure, the median peak valve gradient was 16 mm Hg, with most patients having mild or less aortic insufficiency. The 5-year survival rate was 97.7%.
Conclusions:
- External Ross reinforcement is a viable option for pediatric patients when carefully selected.
- The procedure demonstrates acceptable postoperative valve hemodynamics and freedom from reintervention.
- Long-term survival rates are favorable, supporting the use of this technique in pediatric cardiac surgery.
Objective:
External reinforcement of the Ross autograft is well described in adults. However, this technique is poorly studied in pediatric patients, and indications are not strictly defined. We aim to describe our institutions experience with external Ross reinforcement in pediatric patients.
Methods:
Between 2008 and 2023, 43 patients (≤18 years) underwent the Ross procedure with external Dacron graft reinforcement. Baseline characteristics, echocardiographic measurements, and postoperative outcomes were analyzed. The median [range] follow-up (years) was 2.01 [0.13-14.94] in children <13 years and 1.31 [0.05-11.57] in adolescents 13-18 years (P = .505).
Results:
The median age [range] was 14 years [5-18], median weight was 56 kg [19-142], and the median body surface area was 1.6 m2 [0.7-2.2]. A total of 39 of 43 patients had aortic insufficiency (AI) or mixed stenosis with insufficiency, and 4 of 43 had stenosis alone. The median [range] preoperative pulmonary valve diameter was 2.1 cm [1.8-2.9] and the median [range] aortic valve annulus diameter was 2.4 cm [1.2-3.7]. The most common Dacron graft size was 26 mm. The operative mortality rate was 1 of 43 (2.3%), and there were 5 of 43 (12%) unplanned cardiac reoperations in the postoperative period. At 1 month postprocedure, the median [range] peak valve gradient was 16 mm Hg [2-35] and 2 patients had moderate AI with the remainder having mild or less AI. There was one patient who required late autograft reintervention at 10 years for autograft stenosis. The 5-year Kaplan-Meier survival was 97.7% (93.3%-100.0%).
Conclusions:
With careful patient selection, external Ross reinforcement can be performed in the pediatric population and achieves acceptable postoperative valve hemodynamics, survival, and freedom from reintervention.
