Abstract
BackgroundThe ideal prosthesis for aortic valve replacement in children and young adults has not been found yet. In recent years there has been a renewed interest in the replacement of aortic valve with the pulmonary autograft owing to its advantages of lack of anticoagulation, potential for growth and excellent haemodynamic performance. The purpose of this study was to review our institutional experience at Alder Hey hospital with the Ross procedure in children and young adults.MethodsFrom November 1996 to September 2003, 38 patients (mean age, 13.1 ± 5.7 years) underwent the Ross procedure for various aortic valve diseases using the root replacement technique. Clinical and echocardiographic follow-up was performed early (within 30 days), 3 to 6 months, and yearly after surgery. Medical records of all patients were reviewed retrospectively.ResultsThere was 1 perioperative death. The patients were followed-up for a median interval of 36 months and up to 7 years. One patient died 3 years after surgery secondary to ventricular arrhythmia with overall mortality of 5.3%. Actuarial survival at 7 years was 94 ± 2.5% and there was 100% freedom from reoperation for autograft valve dysfunction or any other cause. Balloon dilatation was required in 2 patients for pulmonary homograft stenosis. The haemodynamics at the latest follow-up were also similar to those at the time of discharge after surgery. There was no progression in the degree of aortic regurgitation for 11 patients with trivial and 3 with mild regurgitation.ConclusionOur experience demonstrates that Ross operation is an attractive option for aortic valve replacement in children and young adults. Not only can the operation be accomplished with a low operative risk but the valve function stays normal over a long period of time with minimal alteration in lifestyle and no need for repeated operations to replace the valve as a result of somatic growth of the children.
Highlights
The ideal prosthesis for aortic valve replacement in children and young adults has not been found yet
AFiggeudriest2ribution of Ross procedure Age distribution of Ross procedure accept the technique of Ross owing to the complexity of the procedure and the unknown fate of the pulmonary autograft
It is obvious that aortic valve replacement with the classic valvular prostheses is not without the well known disadvantages of degeneration of bioprostheses [3], thrombo-embolic phenomena and anticoagulationrelated bleeding due to mechanical prostheses [4], and need for repeated operations in younger patients due to continued somatic growth
Summary
The ideal prosthesis for aortic valve replacement in children and young adults has not been found yet. The purpose of this study was to review our institutional experience at Alder Hey hospital with the Ross procedure in children and young adults. AFiggeudriest2ribution of Ross procedure Age distribution of Ross procedure accept the technique of Ross owing to the complexity of the procedure and the unknown fate of the pulmonary autograft In those days classic valvular prostheses were regarded as the usual option for aortic valve replacement. The ideal valve replacement, in a child, ought to be accomplishable with a low operative risk It should restore normal valve function, and ventricular function should be returned to as close to normal as possible. The purpose of this study was to review our institutional experience with the Ross procedure in children and young adults
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