title: Results of the Ross operation in a pediatric population.
abstract: OBJECTIVE
  To analyse the results of the mid-term clinical and echocardiographic follow-up of the pediatric Ross operation.
  
  
  METHODS
  Echo-Doppler follow-up of 53 consecutive pediatric Ross procedures performed between 1994 and 2003. Median age was 9.7 years at time of operation (2 weeks-17.7 years). Six patients were younger than 3 months. Median age at follow-up was 15.6 years. Aortic valve/left ventricular outflow tract (LVOT) anomalies were congenital in 49 (92%). Seventy percent had previous surgery or balloon valvuloplasty. Root replacement was used in all. Thirteen patients (25%) had LVOT enlargement. Mean cross-clamp time was 113 (69-189) minutes.
  
  
  RESULTS
  Early mortality occurred in 3 patients after emergency surgery following balloon failure (n=1) and extended Ross following interrupted arch/VSD repair (n=2). Late mortality was due to LV fibroelastosis in 2 patients and complicated pulmonary artery stenting in another. RVOT reoperations were required because of late homograft obstruction in 2 patients and because of pulmonary artery stenosis in another. Five patients (9.4%) were reoperated for pulmonary autograft dilatation (n=3) and for leaflet fibrosis or perforation (n=2). Autografts were repaired in two patients, while a mechanical valve was inserted in 3 cases. At 9 years the actuarial survival and event free survival were 89 and 74%, respectively. At last follow-up 90% of autograft diameters indexed to body surface area was above the 90th percentile of normal aortic root diameters. LVOT and RVOT gradients were low and autograft insufficiency was trivial to mild in 84% and mild to moderate in 16%. Autograft stenosis was not noticed.
  
  
  CONCLUSIONS
  The pediatric Ross procedure remains an important tool but autograft dilatation also occurs in the pediatric population. The significance of this finding has yet to be determined.
authors.affiliation: Department of Cardiothoracic Surgery D6-26, Leiden University Medical Center, 2300 RC Leiden, The Netherlands. m.g.hazekamp@lumc.nl
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
authors.forename: Heynric B
authors.initials: HB
authors.lastname: Grotenhuis
authors.forename: Paul H
authors.initials: PH
authors.lastname: Schoof
authors.forename: Marie E B
authors.initials: ME
authors.lastname: Rijlaarsdam
authors.forename: Jaap
authors.initials: J
authors.lastname: Ottenkamp
authors.forename: Robert A E
authors.initials: RA
authors.lastname: Dion
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011664:Pulmonary Valve; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome