Over 25 Years of Experience with the Ross Procedure in Children: A Single-Centre Experience.

Abstract

BACKGROUND\nAortic valve replacement in children represents an important challenge. Concerns regarding pulmonary autograft and homograft longevity requiring reoperations are well recognized. Very long-term outcomes following the Ross procedure are still unknown. We reviewed our experience with the Ross procedure aiming to define very long-term survival rate and freedom from reintervention.\n\n\nMETHODS\nThis is a single-center retrospective cohort including 63 consecutive children who underwent the Ross procedure. Median follow-up duration was 20.5 years. Time-related events were assessed using Kaplan-Meier estimator.\n\n\nRESULTS\nThere were 51 males (81%), mean age 10.1±5.8 years. Isolated aortic stenosis was the most common diagnosis (n=29, 46%) and 34 patients (54%) previously underwent cardiac surgery. There was one (1.6%) in-hospital death. Overall survival at 5, 15 and 25 years was 96.7%, 94.4% and 94.4%, respectively. Freedom from any autograft-related reintervention was 98.1%, 86.4% and 61.2% at 5, 15 and 25 years, respectively. Fifteen patients (24%) underwent autograft reoperations. Among them, 10 patients (67%) underwent valve-sparing autograft reoperation. Freedom from any pulmonary conduit reintervention was 93.2%, 58.2% and 28.3% at 5, 15 and 25 years, respectively. Thirty patients (46.6%) underwent conduit reintervention (8 percutaneous, 22 surgical replacements).\n\n\nCONCLUSIONS\nPediatric Ross procedure is associated with excellent long-term survival. Ross-related reinterventions are more than twice as common on the pulmonary homograft than the autograft.