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Ann Thorac Surg 2001;71:S336-S339
© 2001 The Society of Thoracic Surgeons

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Autografts, allografts, and biological valves in children

Midterm results of the Ross procedure

^a Department of Cardiothoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
^b Division of Pediatric Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

Address reprint requests to Dr Wells, Division of Cardiothoracic Surgery, Keck School of Medicine, University of Southern California, Children’s Hospital Los Angeles, 4650 Sunset Blvd MS 66, Los Angeles CA 90027
e-mail: wwells{at}chla.usc.edu

Presented at the VIII International Symposium on Cardiac Bioprostheses, Cancun, Mexico, Nov 3–5, 2000.

Background. The optimal hemodynamic performance and potential growth of the pulmonary autograft has led to expanded indications for the Ross procedure. We reviewed our institutional experience to assess midterm results with the Ross operation.

Methods. In a 7-year period (1992 to 1999), 111 patients with a median age of 15.7 years (range 2 days to 67 years), underwent the Ross procedure. Ninety-five patients had isolated aortic valve disease and 16 pediatric patients had a more complex left ventricular outflow tract obstruction.

Results. There were 3 early (2.7%) and 3 late deaths over a median follow-up of 3.6 years (range 6 months to 7.6 years). Actuarial survival at 5 years was 94% ± 2%. In pediatric patients, the pulmonary autograft annulus enlarged from 14.7 ± 6.2 mm to 22 ± 6.3 mm. This growth followed the expected increase in pulmonary valve diameter based on body surface area. Eight reoperations were necessary for autograft insufficiency at a median interval of 14 months (range 2 days to 31 months). Freedom from replacement of the pulmonary autograft was 91% ± 3% at 5 years. Three patients developed important obstruction of the pulmonary homograft requiring reoperation at a median of 29 months (range 9 to 31 months).

Conclusions. The Ross procedure can be performed with good midterm results. In pediatric patients, autograft growth has been appropriate. The potential for development of important autograft insufficiency suggests close follow-up through the intermediate and late term.

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