The Ross Operation in Children and Young Adults: A Fifteen-Year, Single-Institution Experience

Clark, Joseph B.; Pauliks, Linda B.; Rogerson, Ashley; Kunselman, Allen R.; Myers, John L.

doi:10.1016/j.athoracsur.2010.12.070

Cited by 18 publications

(13 citation statements)

References 21 publications

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“…15,16 Although not always possible owing to anatomic defects and clearly a more technically demanding procedure, several large studies including our own have shown excellent midterm and long-term results. [17][18][19][20] Our current study confirms excellent outcomes of patients with low rates of reoperation and death. We have adopted a selective approach to the Ross procedure in smaller patients and have often ''staged'' smaller children with an intervening homograft before the index Ross procedure with good results.…”

Section: Discussionsupporting

confidence: 70%

Contemporary experience with surgical treatment of aortic valve disease in children

Khan

Samayoa

Chen

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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AoV repairs and replacements were generally found to be associated with low death and reoperation rates at long-term follow-up. Infants had a lower freedom from reintervention or death after either an AoV repair or replacement, although truncal valve repairs and AoV replacement in patients with concomitant CHD were associated with lower valve survival. Among the valve options, homograft root replacement had a higher risk of death/reoperation and lowest freedom from reintervention or death.

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Section: Discussionsupporting

confidence: 70%

Contemporary experience with surgical treatment of aortic valve disease in children

Khan

Samayoa

Chen

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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“…5,10,15 In the present study, risk factors on univariate analysis for any reoperation included younger age at surgery, lower operative weight, and smaller implanted conduit diameter. This is consistent with Clark et al 10 who reported that patient age and homograft size to influence the longevity of the pulmonary homograft. The findings of smaller homograft size and younger age at operation as risk factors for reoperation are apparent in other pediatric patients undergoing RV‐to‐PA conduit surgery.…”

Section: Discussionmentioning

confidence: 88%

“…This is comparable to the reported 10-year rate of freedom of conduit reoperations of other centers. 5,10,15 In the present study, risk factors on univariate analysis for any reoperation included younger age at surgery, lower operative weight, and smaller implanted conduit diameter. This is consistent with Clark et al 10 who reported that patient age and homograft size to influence the longevity of the pulmonary homograft.…”

Section: Discussionmentioning

confidence: 88%

“…5–10 However, younger age at the time of the Ross procedure appears to be a risk factor for mortality and reoperation. 11–12 Progressive neoaortic valve insufficiency (AI) and the need to replace the right ventricular outflow tract (RVOT) conduit in a growing child are key issues.…”

Section: Introductionmentioning

confidence: 99%

“…R eplacement of the aortic valve with a pulmonary autograft (Ross procedure) was introduced in the late 1960s, 1 and good results have been reported in both adults [2][3][4] and children. [5][6][7][8][9][10] However, younger age at the time of the Ross procedure appears to be a risk factor for mortality and reoperation. 11,12 Progressive neoaortic valve insufficiency (AI) and the need to replace the right ventricular outflow tract (RVOT) conduit in a growing child are key issues.…”

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confidence: 99%

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Ross Procedure in Children: 17‐Year Experience at a Single Institution

Tanny

Yong

d’Udekem

et al. 2013

JAHA

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BackgroundThe Ross procedure in children carries substantial mortality and reoperation rate. Aortic root dilatation is of concern. To prevent dilatation of the neoaortic root, but permit normal growth, we began to apply an absorbable poly‐(p‐dioxanone)‐filaments (PDS) band at the sino‐tubular (ST)‐junction.Methods and ResultsAll children (n=100) who underwent Ross procedure during 1995–2012 were studied. Mean age at operation was 8.6±6.1 years (median 8.3 years, range 3 days to 18 years); 19 patients were younger than 1 year of age. The root replacement (n=91, Ross‐Konno procedure in 29 patients), root inclusion (n=6), and subcoronary implantation (n=3) techniques were used. Operative mortality was 6% (6/100, 4 neonates, 2 infants). Age of <1‐year at time of operation was a risk factor for early death (P<0.001). Mean follow‐up time was 7.0±4.8 years (median 7.4 years, range 5 days to 16 years). Late mortality was 4.3% (4/94). Freedom from moderate or greater neoaortic valve insufficiency (AI) at 5 and 10 years was 89% and 83%, respectively. Freedom from neoaortic valve reoperation at 5 and 10 years was 96% and 86%, respectively. Aortic dilatation to Z‐score >4 was greatest at the ST‐junction (23%, 11/48) compared to the aortic annulus (17%, 11/66) and sinuses (14%, 7/50). Since 2001, a PDS band was placed around the ST‐junction in 19 patients. Survivors with the PDS band had less AI (0 versus 20%, P=0.043) compared to survivors (n=35) without the PDS at 4.1±3 years.ConclusionsThe Ross procedure in children can be performed with acceptable results. Children younger than 1 year of age have higher mortality, but not an increased autograft reoperation rate. Stabilization of the ST‐junction may reduce AI.

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Dilatation and Dysfunction of the Neo-aortic Root and in 76 Patients After the Ross Procedure

et al. 2016

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Pulmonary autograft replacement (Ross procedure) is used as an alternative to prosthetic aortic valve replacement patients with aortic valve disease. There are limited data on incidence and risk factors for dilatation and dysfunction of the neo-aortic after the Ross procedure. Ross procedure was performed in 100 patients at our institution between 1993 and 2011. In 76 patients, complete follow-up data were available. Their median age at surgery was 16 (0.4-58) years (76 % males; 95 % with congenital aortic valve disease). Median follow-up duration was 5.2 years (0.3-16.0 years). We analyzed their clinical and echocardiographic follow-up to identify possible risk factors for neo-aortic root dilatation and dysfunction. Ross procedure included reduction plasty of the native ascending aorta in 25 % of patients. During follow-up, 21 patients (28 %) developed neo-aortic root dilatation, 38 patients (50 %) dilatation oft the native ascending aorta and 7 patients (9 %) at least moderate neo-aortic regurgitation. Univariate risk factors for neo-aortic root dilatation were preoperative aortic regurgitation (p = 0.04), concomitant reduction plasty of the ascending aorta (p = 0.009) and a longer duration of follow-up (p = 0.005). Younger age at surgery was associated with dilatation of the ascending aorta (p = 0.03). Reoperation on the neo-aortic root because of severe dilatation was necessary in 6 patients (8 %), where 2 patients had at least moderate neo-aortic root regurgitation. Neo-aortic root and aortic dilatation are common after the Ross procedure. This is often combined with neo-aortic valve dysfunction. Close follow-up of these patients is mandatory.

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The Ross Operation in Children and Young Adults: A Fifteen-Year, Single-Institution Experience

Cited by 18 publications

References 21 publications

Contemporary experience with surgical treatment of aortic valve disease in children

Contemporary experience with surgical treatment of aortic valve disease in children

Ross Procedure in Children: 17‐Year Experience at a Single Institution

Dilatation and Dysfunction of the Neo-aortic Root and in 76 Patients After the Ross Procedure

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