Abstract:The use of pulmonary autograft was first reported in 1967 by Ross for the treatment of aortic valve disease in adults. Since that time, Ross procedure has been applied to a variety of forms of aortic stenosis and left ventricular outflow tract obstruction and mitral valve disease, Ross procedure has undergone several modifications, such as the root replacement method, inclusion cylinder technique, annular reduction, Konno root enlargement procedures and replacement of the mitral valve with a pulmonary autograft （Ross-Kabbani procedure or Ross Ⅱ procedure）. Advantages of Ross procedure in women of childbearing age, children and young adults include freedom from anticoagulation, appropriate sizing, cellular viability with growth potential proportional to somatic growth, acceptable long-term durability, excellent hemodynamic performance and decreased susceptibility to endocarditis. Surgical technical aspects, indications, selection criteria for the Ross procedure and its modifications, their applicability in the surgical management of aortic stenosis, left ventricular outflow tract obstruction and mitral valve disease and clinical outcome of Ross procedure are reviewed in this article.
Objective To compare the short- and med-term outcomes of aortic valve plasty (AVP) and Ross surgery in children with severe aortic valve disease. Methods The patients (aged<18 years) with severe aortic valve disease who underwent AVP (an AVP group) or Ross surgery (a Ross surgery group) at the Department of Cardiovascular Surgery, West China Hospital from January 2019 to September 2023 were retrospective included. We collected preoperative, intraoperative, and postoperative follow-up data of the patients and compare them between groups. Results A total of 48 pediatric patients were included, including 28 males and 20 females, with an average age of 9.3±4.5 years. There were 25 patients in the AVP group, and 23 in the Ross group. Leaflet thinning [15/25, (60.0%)] and leaflet extension [10/23, (40.0%)] were the most common strategies used in the AVP group, while root replacement technique [12/23, (52.2%)] and subcoronary technique [10/23, (43.5%)] were the most frequently used strategies in the Ross group. There was no in-hospital death. The median follow-up time was 16.0 (7.0, 30.0) months. Peak flow velocity of the aortic valve was higher in the AVP group [2.0 (1.4, 2.9) m/s vs. 1.2 (1.0, 1.5) m/s, P<0.001], while there was no difference in the postoperative aortic valve regurgitation severity between the two groups (P=0.127). Two (8.0%) patients in the AVP group underwent reoperation during follow-up, and 3 (13.0%) in the Ross group. The overall reoperation rate and aortic valve reoperation rate were similar between the two groups (8.0% vs. 13.0%, P=0.922; 8.0% vs. 0.0%, P=0.266). The rate of recurrent aortic valve disease was higher in AVP group (52.0% vs. 4.3%, P<0.001), while further analysis failed to recognize any risk factors. Conclusions AVP and Ross procedure show similar perioperative safety, besides, survival and reoperation rate. The rate of recurrent aortic valve disease is higher in the AVP group, but further investigations are needed for confirmation.