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Short-term follow up of the Ross operation in children
J Braun1, M G Hazekamp, P H Schoof
1Department of Cardiothoracic Surgery, Leiden University Medical Center, The Netherlands.
Insights
The pulmonary autograft (Ross operation) shows good results for pediatric aortic valve replacement and left ventricular outflow tract reconstruction. This procedure is effective for various complex congenital heart conditions in children.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Aortic Valve Repair
Background:
- Pediatric aortic valve disease presents unique surgical challenges.
- The pulmonary autograft is a viable option for aortic valve replacement and LVOT reconstruction in children.
Purpose of the Study:
- To evaluate the efficacy of the Ross operation for aortic valve replacement and LVOT reconstruction in pediatric patients.
- To assess outcomes in children with complex congenital heart defects undergoing this procedure.
Main Methods:
- Forty-one children (mean age 10.0 years) underwent aortic root replacement with a pulmonary autograft.
- Procedures were performed between 1994 and 1998, often combined with other surgical techniques for conditions like VSD-aortic insufficiency and IAA-B/VSD.
Main Results:
- Low operative mortality (4.9%) and no late mortality observed.
- High functional success with 97% of patients in NYHA class I post-operatively.
- Excellent echocardiographic results with minimal neoaortic or homograft insufficiency and low gradients.
Conclusions:
- The Ross operation yields good results for pediatric LVOT obstruction and aortic insufficiency.
- Aortic stenosis following IAA-B/VSD repair remains a complex surgical challenge.
Background And Aims Of The Study:
Aortic valve disease in the pediatric population poses special problems to surgeons and cardiologists. The pulmonary autograft has proven to be a good alternative for aortic valve replacement and left ventricular outflow tract (LVOT) reconstruction in this special group.
Methods:
Forty-one children (mean age 10.0 +/- 4.8 (SD) years; range: 35 days to 18.8 years) underwent aortic root replacement with a pulmonary autograft between February 1994 and April 1998. Twenty-one patients (51%) had previous cardiac surgery; seven (17%) had balloon valvulotomy. Aortic root replacement was combined with other techniques for various disorders, including tunnel LVOT obstruction, ventricular septal defect (VSD)-aortic insufficiency complex, neoaortic insufficiency following arterial switch procedure, and subvalvular stenosis following correction of type B interruption of the aortic arch (IAA) with VSD (IAA-B/VSD).
Results:
The mean follow up was 1.7 +/- 1.0 years (range 44 days to 4.1 years). Total follow up time was 67.8 patient-years. Two patients, both after repair of interrupted aortic arch, died intraoperatively (4.9%). There was no late mortality. Two patients were reoperated on (5.1%), one for autograft insufficiency due to cuspal perforation and one for right ventricular outflow tract stenosis at the distal anastomosis. Thirty-eight patients (97%) are currently in NYHA class I; one child with a preoperatively poor left ventricular function did not improve and is in class II. At the latest echocardiographic follow up, neoaortic regurgitation was absent in 19% of patients, trivial in 69% and mild in 11%. Homograft insufficiency was absent in 64%, trivial in 31% and mild in 6%. All mean gradients for both autograft and homograft were < 15 mmHg.
Conclusions:
The Ross operation can be performed with good results in infants and children with different forms of LVOT obstruction and aortic insufficiency, though aortic stenosis following IAA-B/VSD repair poses a surgically difficult problem.