Medium-term results from pulmonary autografts after the Ross procedure in children and adolescents.

INTRODUCTION

The Ross procedure is being used increasingly for the treatment of aortic valve problems in children, but the long-term prospects of the pulmonary autograft and its ability to grow continue to be controversial. This study summarises the experience of our centre from using the Ross procedure in children and adolescents.

METHODS

During the period November 1996 to March 2004, 35 children aged 3 months to 18 years (mean 10.6 +/- 5.4 years) and weighing 3.2-71 kg (mean 35.4 +/- 19.8 kg) underwent the Ross procedure for the treatment of aortic valve disease (stenosis--25, 71.4%; regurgitation--5, 14.3%; mixed--5). The majority of patients (n=26, 74.2%) had a history of aortic valve procedures. The technique employed was replacement of the aortic root with the pulmonary autograft. All patients were followed for 16-87 months (mean 37 months) with clinical and echocardiographic examinations, which were performed before discharge, 3-6 months later, and then every year.

RESULTS

Perioperative mortality was zero. There was one late (sudden) death 3 years after the procedure. Actuarial 7-year survival was 97.1 +/- 2.9% and freedom from reoperation for any reason was 100%. Two patients (5.7%) needed balloon dilatation because of pulmonary stenosis. All patients were in New York Heart Association functional class I. Haemodynamic parameters at the last follow-up examination were similar to those immediately post procedure: 12 patients (versus 11) had trivial and 3 mild aortic regurgitation. The pulmonary autograft followed the patient's body growth. The diameter of the aortic annulus increased from 19.1 +/- 3.9 mm to 21.6 +/- 2.8 mm and the diameter of the sinuses of Valsalva from 25.6 +/- 5.8 mm to 28.7 +/- 4.6 mm.

CONCLUSIONS

The Ross procedure seems to be the ideal solution for aortic valve problems in children, because of the small perioperative risk, the excellent haemodynamic results, and the potential of the autograft to grow, as shown by medium-term follow up.