THE ROSS PROCEDURE IN CHILDREN: A TWENTY-FIVE YEAR FOLLOW-UP STUDY

Abstract

Ideal aortic valve substitute in children is still to be defined. The Ross procedure offers advantages such as growth potential and low thrombogenicity. Concerns regarding autograft and homograft longevity as well as subsequent reoperations may limit this prosthetic choice in young patients. We reviewed our 25-year experience with the Ross procedure with the aim of defining survival rate and freedom from reintervention. This is a single-center prospective cohort including fifty-eight consecutive children who had the Ross procedure. The first Ross procedure was performed in 1990. Median follow-up duration was 18.9 years and ranged up to 25 years. Complete postoperative clinical and echocardiographic evaluation was obtained and there was no loss to follow-up. Transthoracic echocardiogram was performed when clinically indicated. There were 48 males (82.8%) with a median age at surgery of 11.3 years (0.04 - 17.9). Indications for surgery were stenosis in 32 (55.2%), regurgitation in 13 (22.4%) and mixed aortic valve disease in 13 (22.4%) patients. Survival at 10 and 25 years was 96.2% and 93.9%, respectively. There was one (1.7%) hospital death and two (3.4%) late deaths. Freedom from pulmonary autograft-related reintervention (the aortic root prosthesis) was 93.9% and 69.7% at 10 and 25 years, respectively. Eleven patients underwent reoperations on the autograft at a median follow-up of 16.1 years. Aortic valve-sparing surgery was performed in 6 patients and a Bentall procedure in 4 patients (3 mechanical, 1 homograft). Over the study period, twice as many patients (34.5%) required pulmonary homograft-related (right ventricular outflow tract) reintervention (10 transcatheter, 10 surgical conduit replacement). Freedom from homograft-related reintervention was 73% and 50.4% at 10 and 25 years, respectively. The Ross procedure is associated with excellent long term survival. Late reintervention for the homograft was more common than for the pulmonary autograft in our cohort.