The Ross Procedure in Pediatric Patients: 10 Years Experience at the Asan Medical Center

Kim, Hee Jung; Seo, Dong Man; Yun, Tae Jin; Park, Jeong Jun; Park, In Sook; Kim, Young Hwue; Ko, Jae Kon

Abstract

BACKGROUND: The Ross procedure is known as a good surgical option for a young age group with aortic valve problems, but few reports on the Ross procedure are available in the Korean literature. This study is a review of our midterm results of 10 year experience with the pediatric Ross operation in Asan Medical Center. MATERIAL AND METHOD: From March 1997 to October 2008, eighteen patients who were aged less than 16 years underwent the Ross procedure. There were 11 males and 7 females. The patients median age was 8.5 years (range: 0.5~14.0). The aortic valve pathophysiology was 6 patients with aortic insufficiency, 4 patients with aortic stenosis, 7 patients with mixed aortic stenoinsufficiencey and 1 patient with infective endocarditis. The valve morphology was bicuspid in 11 and tricuspid in 7. All the patients were operated on with the root replacement technique. All the pumonic valves were replaced with an allograft except for one pericardial monocusp valve. The mean follow up duration was 52.8 months (range: 5.8~138.2 months). We reviewed the echocardiographic data with focusing on the autograft dysfunction and reoperation. RESULT: There was no hospital mortality and late mortality. According to the last echocardiographic data, 2 autografts showed aortic regurgitation grade 2, 4 autografts showed aortic regurgitation grade 1 and the others were less than trivial. Reoperation of the pulmonic position conduit was performed 4 times in three patients. The rate of freedom from reoperation at 5 years was 72.2%. On the serial follow up, the Z-values of the aortic annulus/aortic sinus were changed from 1.6+/-1.7/0.9+/-1.7 at preoperation to 1.8+/-1.6 (p=0.64)/2.2+/- 0.9 (p=0.01) at the last follow-up. There was no significant relation between the growth of the neoaortic root and neoaortic insufficiency.
CONCLUSION
Our midterm results of the Ross procedure in pediatric patients showed good autograft function and growth potential. Yet reoperation due to allograft dysfunction was a major concern.