The Ross procedure in children under ten years of age

Background and aims of the study: The potential advantages of the Ross proc edure in children under 10 years of age have yet to be validated. Concerns remain regarding progressive dilatation of the pulmonary autograft and pote ntial homograft stenosis. We present our experience in this age population. Methods: A retrospective analysis of aortic root replacement using the Ross procedure in 11 young children (nine males, two females; median age 84 mon ths; range 3 months to 10 years) between January 1996 and January 1999 was performed jointly in two pediatric surgical centers. Results: There were no operative deaths. Mean hospital stay was 12 +/- 4 da ys, and mean follow up 14.5 +/- 8 months. The event-free survival (death, r eoperation, endocarditis, arrhythmia) was 100%. Currently, nine children ar e in NYHA functional class I, and two in class II. The autograft and homogr aft were evaluated by serial echocardiography. There was no sign of progres sive dilatation of the autograft. Aortic regurgitation was trivial in four children and mild in seven. No growth of the autograft was noted; this was consistent with minimal somatic growth. Homograft peak gradients remained l ow during the follow up. Conclusions: Although the pulmonary autograft procedure is more complex tha n other types of aortic valve replacement, it can be safely applied in chil dren. Early follow up indicates satisfactory performance of the autograft. If dilatation will not occur, pulmonary root autograft may be an attractive substitute for diseased aortic valves in children.