title: Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry.
abstract: OBJECTIVE
  Children undergoing Ross operation were expected to have longer autograft, but shorter homograft durability compared with adults. In order to define the outcome in the second decade after Ross operation in children, a nationwide review of 23 years of experience was undertaken.
  
  
  METHODS
  305 children underwent Ross operation in 11 paediatric units between 1990 and 2012. Age at surgery was 9.4±5.7 years, indication aortic stenosis in 103 patients, regurgitation in 109 and mixed lesion in 93. 116 (38%) patients had prior procedures. Root replacement was performed in 201 patients, inclusion cylinder in 14, subcoronary grafting in 17 and Ross-Konno in 73.
  
  
  RESULTS
  There were 10 (3.3%) hospital and 12 late deaths (median follow-up 8.7 years). Survival was 93±2% and 89±3% and freedom from any reoperation was 76±3% and 67±6% at 10 and 15 years. 34 children had autograft 37 reoperations (25 replacement, 12 repair): three required transplantation after reoperation. Freedom from autograft reoperation was 86±3% and 75±6% at 10 and 15 years. 32 children had right heart redo procedures, and only 25 (78%) conduit replacements (15-year freedom from replacement, 89±4%). Prior operation (p=0.031), subcoronary implant (p=0.025) and concomitant surgical procedure (p=0.004) were risk factors for left heart reoperation, while infant age (p=0.015) was for right heart. The majority (87%) of late survivors were in NYHA class I, 68% free from medication and six women had pregnancies.
  
  
  CONCLUSIONS
  Despite low hospital risk and satisfactory late survival, paediatric Ross operation bears substantial valve-related morbidity in the first two decades. Contrary to expectation, autograft reoperation is more common than homograft.
authors: Department of Surgery, Pediatric Cardiac Surgery Unit, University of Verona, Verona, Italy.
authors: Giovanni Battista
authors: GB
authors: Luciani
authors: Department of Surgery, Pediatric Cardiac Surgery Unit, University of Verona, Verona, Italy.
authors: Gianluca
authors: G
authors: Lucchese
authors: Bambino Gesù Pediatric Hospital, Rome, Italy.
authors: Adriano
authors: A
authors: Carotti
authors: Bambino Gesù Pediatric Hospital, Rome, Italy.
authors: Gianluca
authors: G
authors: Brancaccio
authors: Regina Margherita Pediatric Hospital, Turin, Italy.
authors: Piero
authors: P
authors: Abbruzzese
authors: Monaldi Hospital, Naples, Italy.
authors: Giuseppe
authors: G
authors: Caianiello
authors: Department of Cardiac Surgery, Spedali Riuniti, Bergamo, Italy.
authors: Lorenzo
authors: L
authors: Galletti
authors: University of Bologna, Bologna, Italy.
authors: Gaetano Domenico
authors: GD
authors: Gargiulo
authors: Niguarda Hospital, Milan, Italy.
authors: Stefano Maria
authors: SM
authors: Marianeschi
authors: Department of Surgery, Pediatric Cardiac Surgery Unit, University of Verona, Verona, Italy.
authors: Alessandro
authors: A
authors: Mazzucco
authors: Department of Surgery, Pediatric Cardiac Surgery Unit, University of Verona, Verona, Italy.
authors: Giuseppe
authors: G
authors: Faggian
authors: Apuano Pediatric Hospital, Massa, Italy.
authors: Bruno
authors: B
authors: Murzi
authors: University of Bologna, Bologna, Italy.
authors: Carlo
authors: C
authors: Pace Napoleone
authors: Lancisi Hospital, Ancona, Italy.
authors: Marco
authors: M
authors: Pozzi
authors: Gaslini Pediatric Hospital, Genoa, Italy.
authors: Lucio
authors: L
authors: Zannini
authors: San Donato Hospital, Milan, Italy.
authors: Alessandro
authors: A
authors: Frigiola
mesh_terms: D000293:Adolescent; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012042:Registries; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D014182:Transplantation, Autologous / Q000401:mortality / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000401:mortality / Q000706:statistics & numerical data
keywords: Congenital Heart Disease