Optimized outcome of the Ross procedure in children: single-centre experience†.

Objectives: The Ross procedure with autograft reinforcement has been proposed as a strategy to prevent autograft failure in adults, but outcome data in children during somatic growth remain limited. We investigated long-term outcomes following an individualized autograft reinforcement protocol to evaluate survival and reintervention rates.

Methods: Between January 1995 and December 2022, 233 patients <18 years [median age: 7 (1-13) years] underwent the Ross procedure, including 60 infants (26%). Most frequently free-root autograft implantation without reinforcement was performed (n = 156, 67%). Autograft reinforcement was applied in 77 patients (33%) using either subcoronary implantation (n = 65, 28%) or external prosthetic support (n = 12, 5%). Kaplan-Meier survival estimates were used for survival and reintervention analyses. Risk factors for reintervention were identified by Cox proportional hazards regression.

Results: Reinforcement was associated with improved survival (5-year survival rates of 97.1% vs 87.0%, 10-year survival rates of 97.1% versus 86.99%, P = 0.017). No differences in autograft reintervention between the groups were found (1-year rates of 100% vs 99.4%, 5-year rates of 100%, P = 0.4852). Right ventricle-pulmonary artery (RV-PA) reintervention-free survival at 5 years was higher for homografts compared to xenografts (96.9% vs 79.4%, P < 0.001).

Conclusions: The Ross procedure in children demonstrated excellent long-term outcomes with low autograft reintervention rates in both groups. Reinforcement was associated with improved long-term survival while autograft-related reinterventions did not differ significantly between groups. Older age at Ross and homograft use correlated with lower RV-PA reintervention risk. Multicentre evaluation of reinforcement techniques is required to assess the outcome differences observed in this single-centre experience.