Short-term follow up of the Ross operation in children

Background and aims of the study: Aortic valve disease in:the pediatric pop ulation poses special problems to surgeons and cardiologists. The pulmonary autograft has proven to be a good alternative for aortic valve replacement and left ventricular outflow tract (LVOT) reconstruction in this special g roup. Methods:Forty-one children (mean age 10.0 +/- 4.8 (SD) years; range: 35 day s to 18.8 years) underwent aortic root replacement with a pulmonary autogra ft between February 1994 and April 1998. Twenty-one patients (51%) had prev ious cardiac surgery; seven (17%) had balloon valvulotomy. Aortic root repl acement was combined with other techniques for various disorders,including tunnel LVOT obstruction, ventricular septal defect (VSD)-aortic insufficien cy complex, neoaortic insufficiency following arterial switch procedure, an d subvalvular stenosis following correction of type B interruption of the a ortic arch (IAA) with VSD (IAA-B/VSD). Results: The mean follow up was 1.7 +/- 1.0 years (range 44 days to 4.1 yea rs). Total follow up time was 67.8 patient-years. Two patients, both after repair of interrupted aortic arch, died intraoperatively (4.9%). There was no late mortality. Two patients were reoperated on (5.1%), one for autograf t insufficiency due to cuspal perforation and one for right ventricular out flow tract stenosis at the distal anastomosis. Thirty-eight patients (97%) are currently in NYHA class I; one child with a preoperatively poor left ve ntricular function did not improve and is in class II. At the latest echoca rdiographic follow up, neoaortic regurgitation was absent in 19% of patient s, trivial in 69% and mild in 11%. Homograft insufficiency was absent in 64 %, trivial in 31% and mild in 6%. All mean gradients for both autograft and homograft were <15 mmHg. Conclusions: The Ross operation can be performed with good results in infan ts and children with different forms of LVOT obstruction and aortic insuffi ciency, though aortic stenosis following IAA-B/VSD repair poses a surgicall y difficult problem.