Comparative Analysis of Ross Procedure Outcomes on the Aortic Root Before and After Age 16

Introduction

To evaluate the long-term outcomes of the Ross/Ross-Konno procedure in patients under 16 years of age compared to those over 16, with a focus on the hemodynamic performance of the pulmonary autograft.

Method

A retrospective analysis was conducted on patients operated between 1992 and 2024. Data were collected from hospital records, with complete follow-up for 90% of patients (10% lost to follow-up abroad). Two groups were formed: children (0–16 years) and adults (> 16 years). The primary endpoint was survival.

Results

Among the 171 patients included, 83 were under 16 years old (median age: 8.5 years) and 88 were adults (median age: 26.4 years). Before surgery, 36.5% of children had aortic stenosis, 26.5% had regurgitation, and 37% had mixed disease, compared to 34%, 37.5%, and 28.5% respectively in adults. Early mortality was 3.6% in children and 1.1% in adults. Seven late deaths were recorded. Twenty-year survival was 87% in patients under 16 and 96% in adults (P = 0.2) (Figure 1). Freedom from autograft reoperation at 20 years was 84% in children versus 82% in adults (P = 0.67). However, reinterventions on the right ventricular outflow tract were more frequent in younger patients (47% vs. 82% at 20 years, P < 0.001). At the end of follow-up, the diameter of the sinus of Valsalva was 37.7 ± 9 mm in children compared to 39.7 ± 7 mm in adults.

Conclusion

The Ross procedure provides good autograft growth in younger patients, with performance comparable to adults. However, patients under 16 require more frequent reinterventions on the pulmonary homograft.