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The Ross operation in children: 10-year experience
R C Elkins1, C J Knott-Craig, K E Ward
1Section of Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA.
Insights
The Ross operation offers excellent long-term survival and function for pediatric aortic valve replacement, with most patients maintaining an active lifestyle without anticoagulants.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Aortic Valve Disease
Background:
- The Ross operation, a pediatric aortic valve replacement technique introduced in 1968, presents unique surgical challenges.
- Despite technical demands, its potential as an ideal aortic valve replacement warrants continued investigation.
Purpose of the Study:
- To evaluate the midterm and long-term outcomes of the Ross operation in pediatric patients.
- To assess the durability and functional results of autograft and homograft valves used in the Ross procedure.
Main Methods:
- A retrospective review of 150 consecutive pediatric patients (age 7 days to 21 years) who underwent the Ross operation.
- Follow-up data collected within 12 months, with echocardiographic assessments performed within 1-2 years post-operation.
Main Results:
- Eight-year survival rate was 97.3%.
- Freedom from reoperation for autograft dysfunction was 90% +/- 4% at 8 years; for homograft obstruction, it was 94% +/- 3%.
- All patients reported a normal, active lifestyle without the need for anticoagulation therapy.
Conclusions:
- The Ross operation is a highly effective and preferred aortic valve replacement strategy for children.
- The procedure demonstrates favorable long-term results, including excellent survival and valve function, enabling an active lifestyle.
Background:
The Ross operation, first performed in children in 1968, may be the ideal aortic valve replacement. Technical demands of the operation and two valves at risk have delayed acceptance. A review of our experience to assess midterm and long-term results with the Ross operation is presented.
Methods:
The records of 150 consecutive patients, aged 7 days to 21 years (median age, 12 years, 75% less than 15 years) were reviewed. Follow-up was complete within the last 12 months (median, 2.8 years; range, 1 month to 10 years). Echocardiographic assessment was available on 116 (71%) within 1 year of closure and in 136 (91%) within 2 years.
Results:
Survival was 97.3% at 8 years. Late autograft valve dysfunction required replacement in 2 and reoperation with restitution of autograft function in 6. Freedom from reoperation for autograft dysfunction is 90% +/- 4% at 8 years. Freedom from reoperation for homograft obstruction is 94% +/- 3% at 8 years. Pulmonary homograft dysfunction (gradient > 40 mm Hg) was present in 4 additional patients. Freedom from reoperation on the homograft or a gradient of 40 mm Hg is 89% +/- 4% at 8 years. All patients have a normal, active lifestyle, without anticoagulants for their aortic valve replacement.
Conclusions:
The Ross operation is the preferred operative replacement in children requiring aortic valve replacement.