Treatment of congenital aortic valve stenosis: impact of the Ross operation

Goal: To evaluate the impact of the Ross operation, recently (1997) introdu ced in our unit, for the treatment of patients with congenital aortic valve stenosis. Methods: The period from January 1997 to December 2000 was compared with th e previous 5 years (1992-96). Thirty-seven children (<16 yrs) and 49 young adults (16-50 yrs) with congenital aortic valve stenosis underwent one of t hese treatments: percutaneous balloon dilatation (PBD), aortic valve commis surotomy, aortic valve replacement and the Ross operation. The Ross operati on was performed in 16 patients, mean age 24.5 yrs (range 9-46 yrs) with a bicuspid stenotic aortic valve, 7/10 adults with calcifications, 2/10 adult s with previous aortic valve commissurotomy, 4/6 children with aortic regur gitation following PBD, and 1/6 children who had had a previous aortic valv e replacement with a prosthetic valve and aortic root enlargement. Results: PBD was followed by death in two neonates (fibroelastosis); all ot her children survived PBD. Although there were no deaths, PBD in adults was recently abandoned, owing to unfavourable results. Aortic valve commissuro tomy showed good results in children (no deaths). Aortic valve replacement, although associated with good results (no deaths), has been recently aband oned in children in favour of the Ross operation. Over a mean follow-up of 16 months (2-40 months) all patients are asymptomatic following Ross operat ion, with no echocardiographic evidence of aortic valve regurgitation in 10 /16 patients and with trivial regurgitation in 6/16 patients. Conclusions: The approach now for children and young adults with congenital aortic valve stenosis should be as follows: (1) PBD is the first choice in neonates and infants; (2) Aortic valve commissurotomy is the first choice for children, neonates and infants after failed PBD; (3) The Ross operation is increasingly used in children after failed PBD and in young adults, eve n with a calcified aortic valve.