Ross Operation in Pediatric Population: Impact of the Surgical Timing and the Native Pulmonary Diameter on the Outcome

Abstract

Background: Aortic valve replacement early in life maybe inevitable at times. Ross operation until presentday remains the favorite surgical option in pediatrics with irreparable aortic valve disease. Nonetheless the necessity for re-operation was always its principal limitation due to aortic valve failure or homograft degeneration. We hereby present our 25 years of experience in pediatric population.Methods: From August 1994 until June 2018, a total of 157 children below 18 years underwent a Ross operation. This retrospective review aims at assessing long-term outcome likewise risk factors for reoperation after Ross procedure.Results: Median age was 10.9 years, of which 7 were infants, 79 children and 71 adolescents. Median follow-up was 14 years. Hospital mortality was 0.6%. Freedom from autograft re-operation for children was 96.7% and 94.1% at 10 and 20 years respectively, whereas for adolescents it was 92.6% and 74.9% at 10 and 20 years. For children freedom from homograft re-operation was 92.5%, 83.5% and 56.2% at 10, 15, and 20 years respectively. While for adolescents, it was 96.8%, 91.8%, and 86.7% at 10, 15, and 20 years. Homograft size (p=0.008) and childhood (p=0.05) were risk factors for homograft re-operation.Pulmonary valve diameter >24 mm (p=0.044) and adolescence (p=0.032) were risk factors for autograft re-operation.Conclusions: Our experience demonstrated excellent early and late survival. Whilst children have preferential outcomes concerning autograft re-operation, those who received a smaller homograft had higher incidences of right-sided re-intervention compared to adolescents. Pulmonary diameter >24mm at surgery was an indicator for future autograft failure.

Paediatric aortic valve replacement using decellularized allografts: a multicentre update following 143 implantations and five-year mean follow-up

“…In young children, it nevertheless has a considerable operative mortality ranging up to 24% for neonates, which is, of course, biased by the severe valvular aortic disease present in these patients [ 5 ]. Conducting a Ross procedure in very young patients also aggravates the rate for redo procedures on the right ventricular outflow tract, which will inevitably result in numerous replacement procedures over a lifetime [ 6 , 7 ]. Aortic root stabilizing techniques in younger children can decrease the growth potential of the pulmonary autograft and are therefore infrequently used.…”