The Ross Operation in Children: Effects of Aortic Annuloplasty

Background: Autograft dilatation and progressive neoaortic regurgitation after the Ross procedure prompted us to perform routine aortic annuloplasty. The purpose of this review is to evaluate the success of this technical modification in preventing autograft failure requiring reoperation. Methods: From 1994 to 2005, 46 children and young adults with a mean age of 12.9 ± 4.9 years (range, 14 months to 21 years) underwent a Ross procedure; 19 of 46 patients had prior aortic valve surgery. Neoaortic valve function and need for reintervention were compared between patients who had a Ross procedure without annuloplasty (n = 20) and those who had an annular reduction prior to the autograft anastomosis (n = 26). Results: There were no early or late deaths during a mean follow-up of 65 ± 36 months. Mean hospital stay was 6.6 ± 2.9 days. Two patients required early intervention (eight days) for significant neoaortic regurgitation; one patient required repair of a left ventricular outflow tract pseudoaneurysm a month after emergent Ross procedure for endocarditis, and one patient required replacement of a stenotic homograft at five years. Five patients (13%) required autograft repair (n = 3) or replacement (n = 2) for progressive neoaortic regurgitation, two of the 26 patients had reduction annuloplasty (8%), and three of the 20 patients did not (15%) (p = 0.6). There was a similar incidence of neo-sinus of Valsalva dilatation 37 mm or greater in patients with (53%) and without (36%) annuloplasty (p = 0.5). Conclusions: The Ross procedure remains an excellent option for valve replacement in children and young adults given the alternatives and can be performed with very low mortality. However, in this series of Ross operations in children, routine use of aortic annuloplasty failed to prevent neoaortic regurgitation requiring reoperation.