Aortic remodeling and pulmonary autograft performance over 2 decades after the Ross procedure in the pediatric and young adult population.

Abstract

The Ross procedure is a well-established treatment for nonrepairable aortic valve disease in children and young adults. This study evaluates the mid- and long-term clinical outcomes of more than 20 years of autograft hemodynamics/performance with the Ross procedure in infants, children, and young adults. We retrospectively analyzed 149 consecutive patients who underwent the Ross procedure at our center between March 1996 and August 2023. All surgeries were performed as root replacements by a single experienced surgeon. Sinus of Valsalva and annulus diameters were measured to calculate z scores from the most recent magnetic resonance imaging follow-up. Aortic and pulmonary valve insufficiency was assessed by magnetic resonance imaging or echocardiography. Median age at surgery was 12.3 years (range, 0-33 years) and median weight 50.1 kg (7.25-126 kg). Most patients had congenital pathology (90%) or aortic valve endocarditis (6.9%). Previous aortic valve interventions had been performed in 66.5%. Hospital mortality was 0%. Postoperative echocardiography showed no or trivial autograft regurgitation in 98.7%. Reoperation for autograft dilatation or insufficiency occurred in 13 patients (8.7%). Homograft degeneration requiring surgical or catheter-based intervention occurred in 24 patients (16%). Freedom from autograft reoperation was 99%, 96%, and 95% at 5, 10, and 15 years; for the pulmonary valve, these rates were 94%, 81%, and 74%, respectively. The Ross procedure provides excellent long-term durability and hemodynamics with freedom from autograft reoperation in young patients. Homograft degeneration remains common but is rarely life-threatening, and catheter-based interventions offer effective management when needed.