title: Patient age at the Ross operation in children influences aortic root dimensions and aortic regurgitation.
abstract: BACKGROUND
  The Ross operation provides the advantage of growth potential of the pulmonary autograft in the aortic position. However, development of autograft dilatation and regurgitation may occur. We sought to assess the progression of autograft diameters and aortic regurgitation (AR) with regard to patient age at the time of the Ross operation.
  
  
  METHODS
  Autograft echo dimensions from 48 children <16 years of age at the time of the Ross operation, who had follow-up echocardiograms at <20 years of age, were analyzed using hierarchical multilevel modeling. The z values of autograft dimensions were calculated according to the normal aortic dimensions. Mean follow-up was 5.1 ± 3.3 years. The mean age at the time of the Ross operation was 10.0 ± 4.3 years.
  
  
  RESULTS
  The mean z values of all patients showed a significant increase with follow-up time at the sinus (0.5 ± 0.1/year, P < .001) and the sinotubular junction (0.7 ± 0.2/year, P < .001) but not at the annulus (0.1 ± 0.1/year, P = .59). There was no significant difference in the z values of sinus and the sinotubular junction between younger and older children at implantation and with time. The initial annulus z value was significantly larger in younger children (P < .0001), whereas the annual increase was significantly higher in older children (P = .021). Age at operation has no impact on the initial AR grade (P = .60). The AR tends to increase more quickly in older patients (P = .040). Sinus and sinotubular junction dilate with time, regardless of patient age.
  
  
  CONCLUSIONS
  Young children show larger initial annulus sizes than older children. However, annulus diameters tend to normalize in young children, whereas they increase in older children. Autograft regurgitation develops slowly, but significantly, and predominantly in older children. Stabilizing measures to prevent autograft root dilatation are warranted in adolescents, but they are not required in young children.
authors: Department of Cardiovascular Surgery, German Heart Center Munich at the Technische Universität München, Munich, Germany.
authors: Jürgen
authors: J
authors: Hörer
authors: Jelena
authors: J
authors: Kasnar-Samprec
authors: Efstratios
authors: E
authors: Charitos
authors: Ulrich
authors: U
authors: Stierle
authors: Ad J J C
authors: AJ
authors: Bogers
authors: Wolfgang
authors: W
authors: Hemmer
authors: Roland
authors: R
authors: Hetzer
authors: Michael
authors: M
authors: Hübler
authors: Derek R
authors: DR
authors: Robinson
authors: Hans H
authors: HH
authors: Sievers
authors: Rüdiger
authors: R
authors: Lange
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001013:Aorta, Thoracic / Q000473:pathology*; D001022:Aortic Valve Insufficiency / Q000473:pathology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery; D064592:Autografts / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000473:pathology / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D007223:Infant; D011183:Postoperative Complications / Q000473:pathology*; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000637:transplantation
keywords: aortic root; aortic valve replacement; autograft; heart valve; pediatric; valve lesions