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The Ross procedure in children
V M Reddy1, D B McElhinney, F L Hanley
1Division of Cardiothoracic Surgery, University of California, San Francisco, USA.
Insights
The Ross procedure, using a pulmonary autograft for aortic valve replacement in children, shows excellent long-term results with high freedom from reoperation and minimal aortic insufficiency. This technique offers a unique growth potential for pediatric patients with congenital heart disease.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The Ross procedure involves aortic valve replacement using a patient's own pulmonary valve (autograft).
- Widespread interest in the Ross procedure for pediatric aortic valve disease has emerged recently.
- The procedure offers potential for growth, crucial for pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and long-term outcomes of the Ross procedure in pediatric patients.
- To assess the need for reoperation and the incidence of autograft insufficiency.
- To determine the suitability of the Ross procedure for complex congenital heart conditions.
Main Methods:
- The Ross procedure was performed on 46 patients, with 40 being 18 years or younger.
- Combined procedures included Konno ventriculoplasty (10 patients) and Ross-Konno for hypoplastic left heart syndrome (3 patients).
- Follow-up ranged from 1 to 38 months, with a median of 22 months.
Main Results:
- No late mortality was observed.
- Freedom from reoperation at 30 months was 89%.
- Most patients exhibited trace or no aortic insufficiency, with only one case of moderate insufficiency and eight of mild regurgitation.
Conclusions:
- The Ross procedure is a significant advancement for treating pediatric aortic valve disease.
- The pulmonary autograft demonstrates durability in the systemic circulation.
- The procedure provides a viable aortic valve replacement with inherent growth potential for children.
Abstract:
Although it has been almost 30 years since Ross described his technique for aortic valve replacement using the pulmonary autograft, only recently has there been widespread interest in the use of the Ross procedure for aortic valve replacement in children with congenital heart disease. Since July 1992 we have performed the Ross procedure in 46 patients, 40 of whom were < or = 18 years of age at the time of surgery. In 10 children the procedure was combined with Konno ventriculoplasty, and in 3 others a Ross-Konno procedure was used for biventricular repair of borderline hypoplastic left heart syndrome. The only early deaths were in two of the patients with borderline hypoplastic left heart syndrome. There has been no late mortality, and two patients have required reoperation: one for recurrent distal aortic arch obstruction, and one for moderate-severe autograft insufficiency. Freedom from reoperation at 30 months is 89%. Aside from one patient with moderate autograft insufficiency and eight with mild regurgitation, all patients have trace or no aortic insufficiency at follow-up ranging from 1 to 38 months (median 22 months). The Ross procedure is an important advance in the treatment of aortic valve disease in pediatric patients. It is the only available replacement for the aortic valve that has growth potential, and there is ample evidence that the pulmonary autograft holds up well in the systemic circulation.