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Original Articles: Cardiovascular

The Ross Procedure in Infants and Young Children

^a Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland
^b Department of Pediatric Cardiac Surgery, Hôpital Necker Enfants-Malades, Paris, France
^c Department of Pediatric Cardiology, Hôpital Necker Enfants-Malades, Paris, France

Accepted for publication July 18, 2007.

^_* Address correspondence to Dr Kadner, Department of Cardiovascular Surgery, University Hospital, Berne, Freiburgerstrasse, Berne, 3010, Switzerland (Email: a.kadner{at}web.de).

Background: This study reviews our experience with the Ross procedure in infants and young children.

Methods: From September 1993 to September 2004, 52 children less than 15 years of age underwent a Ross procedure. The patients ranged in age from 4 days to 15 years old (median, 5 years). Fifteen patients (29%) were less than 2 years of age. The predominant indication for the Ross procedure was aortic stenosis. Sixteen patients underwent a Ross-Konno procedure for severe left ventricular outflow tract obstruction. Thirty-four patients had 48 previous interventions. Preoperatively, 6 patients showed severe left ventricular dysfunction, and 2 of the patients required ventilation and inotropic support. Concomitant procedures were performed in 8 patients. Three patients had a mitral valve replacement, 2 patients had a ventricular septal defect closure and an aortic arch reconstruction, 2 patients had aortic arch reconstructions, and 1 patient had resection of a coarctation and a ventricular septal defect closure.

Results: Patients were followed up for a median of 43 months (range, 1 to 130). Overall survival was 85% ± 5% at 1 and 82% ± 5% at 2, 5, and 10 years. Hospital mortality was 5 of 52 patients (9.6%). All deaths occurred in neonates or infants less than 2 months of age, who needed urgent surgery. Three patients died late of noncardiac causes. At last follow-up, all patients were classified in New York Heart Association functional class I or II. No patient had endocarditis of the autograft or the right ventricular outflow tract replacement. During the follow-up, no event of thrombembolism was observed. No patient required the insertion of a permanent pacemaker. Overall freedom from reoperation is 57% ± 15% at 10 years. One patient required the replacement of the autograft at 6 months postoperatively. The development of mild aortic insufficiency was observed in 24 patients, and moderate aortic insufficiency in 1 patient during follow-up. Freedom from reoperation for the right ventricular outflow tract replacement is 60% ± 15% at 10 years.

Conclusions: The Ross procedure represents an attractive approach to aortic valve disease in young children. However, a high early mortality rate has to be considered when performing this procedure in neonates or infants who present in critical preoperative condition.

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Ann. Thorac. Surg. 2008 85: 808-809. [Extract] [Full Text] [PDF]

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