Aortic remodeling and pulmonary autograft performance over 2 decades after the Ross procedure in the pediatric and young adult population.

OBJECTIVES: The Ross procedure is a well-established treatment for nonrepairable aortic valve disease in children and young adults. This study evaluates the mid- and long-term clinical outcomes of more than 20 years of autograft hemodynamics/performance with the Ross procedure in infants, children, and young adults.

METHODS: We retrospectively analyzed 149 consecutive patients who underwent the Ross procedure at our center between March 1996 and August 2023. All surgeries were performed as root replacements by a single experienced surgeon. Sinus of Valsalva and annulus diameters were measured to calculate z scores from the most recent magnetic resonance imaging follow-up. Aortic and pulmonary valve insufficiency was assessed by magnetic resonance imaging or echocardiography.

RESULTS: Median age at surgery was 12.3 years (range, 0-33 years) and median weight 50.1 kg (7.25-126 kg). Most patients had congenital pathology (90%) or aortic valve endocarditis (6.9%). Previous aortic valve interventions had been performed in 66.5%. Hospital mortality was 0%. Postoperative echocardiography showed no or trivial autograft regurgitation in 98.7%. Reoperation for autograft dilatation or insufficiency occurred in 13 patients (8.7%). Homograft degeneration requiring surgical or catheter-based intervention occurred in 24 patients (16%). Freedom from autograft reoperation was 99%, 96%, and 95% at 5, 10, and 15 years; for the pulmonary valve, these rates were 94%, 81%, and 74%, respectively.

CONCLUSIONS: The Ross procedure provides excellent long-term durability and hemodynamics with freedom from autograft reoperation in young patients. Homograft degeneration remains common but is rarely life-threatening, and catheter-based interventions offer effective management when needed.