The Ross operation: Initial Israeli experience

Background: The need for aortic valve replacement in children and young adu lts poses a special problem to cardiologists and surgeons. Replacing the si ck aortic valve with the patient's pulmonary valve as described by Ross has proven to be a good option in this special age group. Objective: To review our initial experience in order to assess the short-te rm results. Methods: From January 1996 to June 1999, 40 patients (age 8 months to 41 ye ars) underwent aortic valve replacement with pulmonary autograft. Indicatio ns for surgery were congenital aortic valve disease in 30 patients, bacteri al endocarditis in 5, rheumatic fever in 3, and complex left ventricular ou tflow tract obstruction in 3. Trans-esophageal echocardiography was perform ed preoperatively and post-bypass in all patients, and transthoracic echoca rdiography was done prior to discharge and on follow-up. Results: There was no preoperative or late mortality. All patients remain i n functional class I (New York Heart Association) and are free of complicat ions and medication. None showed progression of autograft insufficiency or LVOT obstruction. Homograft insufficiency in the pulmonary has progressed f rom mild to moderate in one patient, and three developed mild homograft ste nosis, Conclusions: The Ross procedure can be performed with good results in the y oung population and is considered an elegant surgical alternative to prosth etic valves and homografts.