Ross procedure for pediatric aortic valve disease.
OBJECTIVE
Currently, prosthetic selection for aortic valve replacement is still debatable in pediatric patients with aortic valve disease. Ross procedure is a time-consuming and demanding technique which may produce good results. This study assessed the results obtained with various methods of right ventricle outflow tract (RVOT) reconstruction in patients receiving Ross procedure.


METHODS
From September 1996 to December 2003, 13 pediatric patients underwent Ross procedure for aortic valve disease. Their ages ranged from 1 month to 17 years (mean, 6.29 +/- 3.62 years; median, 7 years) and 2 patients were less than 1 year of age. Previous procedures in these patients included balloon dilation of the aortic valve in 10 and surgical aortic valvuloplasty in 2. RVOT was reconstructed with heterografts in 3, homografts in 3 or without extracardiac conduits in 7.


RESULTS
There was 1 in-hospital death (7.7%) and 1 late death from a non-cardiac cause. One patient developed infective endocarditis with periaortic abscess 2 weeks after the Ross procedure. Eleven patients were followed for a mean of 3.3 years (range, 8 months to 8 years). There was no significant pressure gradient across the neoaorta. Severe stenosis developed gradually in 3 patients who had RVOT reconstruction with heterograft conduits. All 3 had received RVOT redo operation. None of the patients who received RVOT reconstruction without extracardiac conduits had significant pulmonary stenosis but 6 had regurgitation (nil 1, mild 3, moderate 3). No redo operation was required during follow-up (range, 8 months to 4 years). All of the 11 survivors were in New York Heart Association functional class I.


CONCLUSIONS
This study found satisfactory results of Ross procedure in pediatric aortic valve disease. RVOT reconstruction without extracardiac conduit is a feasible alternative despite the availability of homograft.
Chang
Chung-I
CI
Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei.
Ke
Yu-Chen
YC
Wang
Jou-Kou
JK
Wu
Mei-Hwan
MH
D000293:Adolescent; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000637:transplantation*