The Ross procedure in patients aged less than 18 years: The midterm results

Abstract

The low rate of autograft failure demonstrates that the Ross procedure is an attractive option for the management of aortic valve disease and complex left ventricular outflow tract obstruction in the pediatric population. However, alternative options must be considered in adolescents and young adults.

Long-Term Survival and Reintervention After the Ross Procedure Across the Pediatric Age Spectrum

“…In our assessment of survival, we found that the neonate/infant group had the highest mortality rate. Our 29% in-hospital mortality rate for neonates is comparable with other modern series with reported mortality ranging from 12% to 75% [9,[17][18][19]. No prior studies have reported on long-term survival for infants after the Ross procedure.…”

“…Previous series have reported 74% to 100% freedom from LVOT reintervention in pediatric Ross patients at 10 years; however, nearly all comprised mixed age group cohorts [6,9,15,19].…”

“…The operation offers the possibility of life-long durability of the autograft and is particularly useful in patients with a small aortic root or multilevel left ventricular outflow tract (LVOT) obstruction [4][5][6]. Several disadvantages of the Ross procedure have also been described, including aortic root dilatation and progressive aortic insufficiency (AI) requiring autograft reintervention [7][8][9]. In the pediatric population, right-sided conduit reinterventions are expected [8].…”

“…Studies including pediatric patients have had limitations, including small sample sizes, analysis of mixed cohorts of adults and children, and a focus on midterm outcomes [9,[13][14][15][16]. Long-term outcomes and an understanding of the effect of age at operation remain unclear.…”

Pulmonary autograft in aortic position: is everything known?

“…Observational study (9,(14)(15)(16)18) and more recent randomized study controlled (23)(24)(25) have updated the previous work by including higher-risk patients and reflecting changes in clinical and surgical practice. These studies included large numbers of patients with different aortic disease pathogenesis who were treated with reinforcement of pulmonary autograft (23)(24)(25)51).…”