Surgical outcomes of the reinforced Ross procedure in the pediatric population

Abstract

Objective

External reinforcement of the Ross autograft is well described in adults. However, this technique is poorly studied in pediatric patients, and indications are not strictly defined. We aim to describe our institutions experience with external Ross reinforcement in pediatric patients.

Methods

Between 2008 and 2023, 43 patients (≤18 years) underwent the Ross procedure with external Dacron graft reinforcement. Baseline characteristics, echocardiographic measurements, and postoperative outcomes were analyzed. The median [range] follow-up (years) was 2.01 [0.13-14.94] in children <13 years and 1.31 [0.05-11.57] in adolescents 13-18 years (P = .505).

Results

The median age [range] was 14 years [5-18], median weight was 56 kg [19-142], and the median body surface area was 1.6 m² [0.7-2.2]. A total of 39 of 43 patients had aortic insufficiency (AI) or mixed stenosis with insufficiency, and 4 of 43 had stenosis alone. The median [range] preoperative pulmonary valve diameter was 2.1 cm [1.8-2.9] and the median [range] aortic valve annulus diameter was 2.4 cm [1.2-3.7]. The most common Dacron graft size was 26 mm. The operative mortality rate was 1 of 43 (2.3%), and there were 5 of 43 (12%) unplanned cardiac reoperations in the postoperative period. At 1 month postprocedure, the median [range] peak valve gradient was 16 mm Hg [2-35] and 2 patients had moderate AI with the remainder having mild or less AI. There was one patient who required late autograft reintervention at 10 years for autograft stenosis. The 5-year Kaplan-Meier survival was 97.7% (93.3%-100.0%).

Conclusions

With careful patient selection, external Ross reinforcement can be performed in the pediatric population and achieves acceptable postoperative valve hemodynamics, survival, and freedom from reintervention.