Abstract
Introduction: Aortic valve replacement in children and infants poses an important clinical challenge. The Ross procedure offers advantages such as growth potential and low thrombogenicity. Concerns regarding pulmonary autograft and homograft longevity as well as subsequent reoperations are well recognized. We reviewed our experience with the Ross procedure with the aim of defining survival rate and freedom from reintervention. Methods: This is a single-center retrospective cohort including 63 consecutive children who underwent the Ross procedure. The first Ross procedure was performed in 1990. Complete postoperative clinical and echocardiographic evaluation was obtained. Long-term survival was assessed using Kaplan-Meier estimator. Results: There were 51 males (81%) and mean age at surgery was 10.1 (+/- 5.8) years. Isolated aortic stenosis was the most common diagnosis and found in 28 (44.4%) patients. Median follow-up duration was 20.5 years and ranged up to 26.9 years. There was one (1.6%) hospital death. Survival at 5, 15 and 25 years was 96.6%, 94.4% and 94.4%, respectively. Freedom from autograft-related reintervention was 98.1%, 88.9% and 66.8% at 5, 15 and 25 years, respectively. Twelve patients underwent reoperations on the autograft and there was no post-operative death. Among these patients, 7 (58.3%) patients underwent valve-sparing autograft reoperation. Reintervention on the pulmonary homograft was performed on 29 (46.0%) patients. Freedom from homograft-related reintervention was 93.2%, 58.2% and 29.8% at 5, 15 and 25 years, respectively. Conclusions: The Ross procedure in children is associated with excellent long-term outcomes. Ross-related reinterventions are more than twice as common on the pulmonary homograft than autograft.
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