ROSS PROCEDURE WITH AORTIC ROOT TAILORING FOR AORTIC-VALVE REPLACEMENT IN THE PEDIATRIC POPULATION

Background. Aortic valve replacement with a pulmonary autograft (Ross procedure) is being applied more commonly in children. Although indica tions for this procedure have been expanded, the presence of a dilated aortic annulus has remained a relative contraindication. In this cond ition, the use of an undersized autograft in an enlarged aortic annulu s may result in significant aortic regurgitation. Methods. Among 68 ch ildren and young adults undergoing the Ross procedure, 15 (age range, 8 to 24 years) with severe aortic regurgitation pr stenosis and an aor tic annulus diameter that was at least 2 mm larger than the pulmonary annulus had aortic root tailoring. In this group, the diameter of the aortic annulus measured 26.6 +/- 1.3 mm (mean +/- standard error of th e mean), whereas that of the pulmonary annulus was 22 +/- 0.9 mm. The mean annular difference was 4.6 +/- 0.7 mm (range, 2 to 12 mm). The ao rtic annulus was reduced by excising a triangular wedge of tissue post eriorly from the aortic valve annulus at the level of the commissure b etween the left and noncoronary cusps extending into the anterior leaf let of the mitral valve. The edges were reapproximated over a calibrat ed dilator to adjust the final size of the aortic annulus to 2 mm smal ler than that of the pulmonary autograft. Circumferential felt strips were not used in any patient. Results. All patients survived and morbi dity was limited to one reoperation for bleeding. Doppler echocardiogr aphic examination performed at discharge demonstrated that no patient had more than trace to 1+ aortic regurgitation and none had evidence o f aortic stenosis. Over a mean follow-up period of 6.3 +/- 1.5 months (range, 1 to 16 months) there has been no late morbidity or mortality and no progression of aortic regurgitation. Conclusions. Aortic root t ailoring further extends the use of the Ross procedure to patients wit h excessive aortic annular dilation while maintaining the potential fo r growth, which is particularly important in the pediatric population. (C) 1997 by The Society of Thoracic Surgeons.