Ross operation in children: Late results

Background and aim of the study: Although the Ross operation has become the accepted aortic valve replacement in children, the long-term fate of the p ulmonary autograft valve remains unknown. To assess mid-term and late resul ts of autograft valve durability, patient survival and valve-related morbid ity, a retrospective review of patients (age range: 3 days to 17 years) hav ing a Ross operation between November 1986 and May 2001 were reviewed. Methods: Medical records and patient contacts with all but two of 167 curre nt survivors of 178 consecutive patients having an aortic valve replacement as a Ross operation have been completed during the past two years. The mos t recent echocardiographic evaluation was reviewed for autograft valve and homograft valve function. Results: Operative mortality was 4.5% (8/178), with three late deaths (two were non-valve-related) for an actuarial survival of 92 +/- 3% at 12 years. Actuarial freedom from autograft valve degeneration (reoperation or severe insufficiency of autograft valve or valve-related death) was 90 +/- 4% at 12 years. Autograft valve degeneration was not affected by technique of ins ertion (141 root replacement, 37 intra-aortic), aortic valve morphology (15 7 bicuspid or unicuspid, 26 tricuspid), or age at operation. Autograft valv e degeneration was worse in patients with a primary lesion of aortic insuff iciency than in those with aortic stenosis (p = 0.03). Autograft valve reop eration was required in 12 patients, with autograft valve replacement in se ven. Actuarial freedom from autograft replacement was 93 +/- 3% at 12 years . Homograft valve replacement was required in seven patients, with actuaria l freedom from replacement of 90 4% at 12 years. Eight additional patients have homograft valve obstruction (gradient greater than or equal to 50 mmHg ), and seven have severe pulmonary insufficiency. Conclusion: Survival and freedom from aortic valve replacement are excellen t in children. Homograft valve late function remains a concern, and efforts to improve homograft durability should be encouraged.