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J Thorac Cardiovasc Surg 2001;122:147-153
© 2001 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

The Ross procedure in children and young adults: A word of caution

Antonio Laudito, MDa, Michael M. Brook, MDb, Sam Suleman, BSa, Mark S. Bleiweis, MDa, Lenardo D. Thompson, MDa, Frank L. Hanley, MDa, V. Mohan Reddy, MDa

From the Departments of Pediatric Cardiac Surgerya and Pediatric Cardiology,b University of California, San Francisco, Calif.

Received for publication May 16, 2000. Revisions requested Sept 28, 2000; revisions received Dec 13, 2000. Accepted for publication Dec 15, 2000. Address for reprints: V. Mohan Reddy, MD, Pediatric Cardiac Surgery, University of California, San Francisco, 505 Parnassus Ave, S549, Box 0118, San Francisco, CA 94105-0118.

Abstract

Background: Disease of the aortic valve in children and young adults is a complex entity whose management is the subject of controversy. The Ross and the Ross-Konno procedures have become the primary choices for aortic valve replacement in children because of growth potential, optimal hemodynamic performance, and lack of the need for anticoagulation. However, concern persists regarding the longevity of the pulmonary autograft, especially in patients with aortic insufficiency.
Methods: Between June 1993 and February 2000, 72 Ross and Ross-Konno procedures were performed at our institution: 81% of the patients were less than 15 years old. Preoperative, postoperative, and follow-up clinical, echocardiographic, and hemodynamic data were reviewed. Statistical analysis was performed to identify the risk factors for deteriorating autograft function.
Results: Aortic insufficiency was an indication for the Ross procedure in 17 patients and mixed lesions with predominant aortic insufficiency in 10. Of the 45 other patients, 32 had aortic stenosis and 13 had mixed lesions with predominant aortic stenosis. There were no deaths during a follow-up of 5 to 80 months. Autograft reoperation was necessary in the follow-up period in 7 patients for severe aortic insufficiency. Moderate insufficiency was identified in 5 additional patients. Aortic insufficiency or predominant aortic insufficiency, as a preoperative hemodynamic indication for the Ross procedure, reached statistical significance (P = .031) as a risk factor for autograft failure.
Conclusion: The Ross and the Ross-Konno procedures have changed the prognosis of children and young adults with complex aortic valve disease. However, the Ross procedure should be performed with caution in older children in whom aortic insufficiency is a preoperative hemodynamic indication. Further follow-up to delineate the risk factors for autograft dysfunction in children and young adults is necessary to better define the indications for the Ross procedure.




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