The Ross Operation – a good option in children and adolescents?

Objectives: The Ross Operation has received grown acceptance as anticoagulation-free aortic valve replacement in children and young adults. Until December 2003 we performed 364 Ross Operations and focus the forementioned question in the light of our experience in patients up to 20 years of age.

Material and Methods: Since February 1995 59 young patients (median age 12 years, range 1–20) received their aortic valve replaced with a pulmonary autograft as free-standing root. RVOT was reconstructed with a cryopreserved homograft. Regular echocardiographic follow-up was performed.

Results: Cardiopulmonary bypass- and crossclamp-time was 153.8±27 and 120.8±18min., respectively. Early postoperative complications were pacemaker insertion in one and reentry for bleeding in 2 cases. During follow-up of 40±26 months no thrombembolic or hemorrhagic events were observed. One patient died from myocardial infarction after 3 months.

Echocardiographic follow-up revealed physiological gradients across the autograft with a median mean gradient of 3.3±1.4mm Hg and 13.8±11.2mm Hg across the homograft, with a peak gradient of at least 30mm Hg in 9 patients. Moderate homograft regurgitation without clinical significance was observed in 7 patients. Four patients required replacement of their stenotic homograft. No autograft showed more than first grade regurgitation, despite slight dilatation of the autografts Sinus of Valsalva in most cases.

Conclusions: The Ross Operation can be performed with good results, midterm excellent autograft function and low mortality. Homograft durability is still unpredictable and eventual reoperation and complexity of the procedure demand a word of caution. Physiological autograft hemodynamics and freedom from anticoagulation still justify its use in the young for specialized centers.