Neoaortic Valve and Root Complex Evolution After Ross Operation in Infants, Children, and Adolescents

Abstract

The Ross operation in children and adolescents offers many potential advantages. Concerns have been raised about the long-term development of the neoaortic complex and the risk of dilation. Retrospective analysis of prospectively collected follow-up data in a population of patients who underwent Ross operations when they were younger than 18 years old was conducted. Echocardiographic and clinical data, including survival, need for reoperations, and quality of life, were analyzed in 95 patients for a median follow-up of 84 months. The neoaortic root and sinotubular junction demonstrated dilation that exceeded somatic growth. The neoaortic valve grew in a manner that reflected somatic proportions. Freedom from moderate neoaortic root dilation was 100% at 5 years and 77% after 10 years. Freedom from moderate neoaortic valve insufficiency was 86% at 5 years after the Ross procedure and 63% after 10 years. The use of a proximal anastomosis running suture (p = 0.005) and the degree of neoaortic valve insufficiency (p = 0.032) at discharge were independently associated with the degree of neoaortic valve insufficiency at follow-up. Freedom from neoaortic reintervention was 96% at the 5-year follow-up and 80% at the 10-year follow-up. Predictors of neoaortic reintervention were the use of an operative technique other than aortic root replacement (p = 0.002) and the degree of neoaortic valve insufficiency at discharge (p = 0.005). The Ross operation remains a viable option for children and adolescents with severe aortic valve disease; neoaortic complex dilation occurs but is not directly responsible for neoaortic valve insufficiency, which is the main cause for reoperation.