title: Ross Procedure in Neonates and Infants: A European Multicenter Experience.
abstract: BACKGROUND
  Infants and neonates with severe left ventricular outflow tract obstruction may require pulmonary autograft replacement of the aortic root. In this retrospective multicenter cohort study, we present our experience with the Ross procedure in neonates and infants with a focus on midterm survival and pulmonary autograft durability.
  
  
  METHODS
  A retrospective observational study was performed in 76 infants (aged less than 1 year) operated on in six congenital cardiac centers in The Netherlands and Germany between 1990 and 2013.
  
  
  RESULTS
  Patients had a pulmonary autograft replacement of the aortic valve with (68%) or without (32%) septal myectomy. Median patient age was 85 days (range, 6 to 347). Early mortality (n = 13, 17%) was associated with neonatal age, preoperative use of intravenous inotropic drugs, and congenital aortic arch defects. Five patients (9%) died during follow-up. Freedom from autograft reintervention was 98% at 10 years. Echocardiography demonstrated good valve function, with no or trace regurgitation in 73% of patients. Freedom from right ventricular outflow tract reintervention was 51% at 10 years. Univariable analysis demonstrated superior freedom from reintervention of pulmonary homografts compared with aortic homografts or xenografts.
  
  
  CONCLUSIONS
  Pulmonary autograft replacement of the aortic valve in neonates and infants is a high-risk operation but offers a durable neoaortic valve. Midterm durability reflects successful adaptation of the autograft to the systemic circulation. Late mortality associated with heart failure was an unexpected finding.
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. Electronic address: a.mookhoek@erasmusmc.nl.
authors.forename: Aart
authors.initials: A
authors.lastname: Mookhoek
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany.
authors.forename: Efstratios I
authors.initials: EI
authors.lastname: Charitos
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.affiliation: Department of Cardiovascular Surgery, German Heart Center, Munich, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hörer
authors.affiliation: Department of Cardiovascular Surgery, German Heart Center, Munich, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.affiliation: Department of Congenital Heart Surgery, University Heart Center, Hamburg, Germany.
authors.forename: Joerg S
authors.initials: JS
authors.lastname: Sachweh
authors.affiliation: Department of Congenital Heart Surgery, University Heart Center, Hamburg, Germany.
authors.forename: Arlindo
authors.initials: A
authors.lastname: Riso
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stierle
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, Utrecht University Medical Center, Utrecht, Netherlands.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Schoof
mesh_terms: D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D064592:Autografts; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands; D011664:Pulmonary Valve / Q000637:transplantation*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*