Abstract:

Objective

To explore the early outcomes of pulmonary autograft replacement procedure (Ross procedure) in children and adolescents in our center, and the relationship between postoperative outcomes and surgical strategies.

Method

Children and adolescents who underwent Ross surgery in West China Hospital, Sichuan University from January 2019 to September 2023 were continuously included. Baseline data such as the type and severity of patients' aortic valve lesions,intraoperative data such as surgical strategies and time, and postoperative follow-up data such as the degree of aortic regurgitation and transvalvular pressure gradients were retrospectively collected and statistical analyzed.

Results

A total number of 24 children and adolescents received Ross procedure in our center, and their mean age was (12.6 ± 6.4) years, and 12 (50.0%,12/24) of them were male. 17 patients (70.8%,17/24) had a bicuspid aortic valve, and aortic stenosis was the main pathological change of the aortic valve (11/24, 45.8%). 12 patients (50.0%,12/24) received the Ross procedure with the Root replacement technique, and 10 (41.7%,10/24) with the Subcoronary technique, while the other 2 with reinforcement technique and Inclusion technique respectively.There was no perioperative death, the operative time of Root replacement group was significantly longer than that of the Subcoronary group [(487.5 ± 106.7) min vs. (382.1 ± 57.2) min, P=0.027],while the corss-clamp time, bypass time and intensive care unit(ICU), stay were comparable between groups. The mean follow-up time was (20.4 ± 17.9) months, with no late mortality. 17 patients (70.8%,17/24) were classified as New York Heart Association Ⅰ, and 5 (20.8%,5/24) were classified as New York Heart Association(NYHA) Ⅱ, while it was NYHA Ⅲ for the other 2 (8.3%).Postoperative antegrade flow velocity for aortic valve was (1.3 ± 0.4) m/s, and no patient developed moderate or more aortic regurgitation postoperatively. Postoperative antegrade flow velocity for pulmonary valve was (2.3 ± 1.0) m/s, and there were 2 patients who developed moderate or more pulmonary regurgitation postoperatively (both patients' right ventricular outflow tract reconstruction was performed with Gore-Tex valved conduits). Three patients received reoperation due to right ventricle to pulmonary artery conduit failure at 9, 10 and 30 months after surgery respectively.

Conclusion

Ross procedure can achieve a fairly promising early outcome among children and adolescents. Except for the longer surgical time in the Root replacement group, the outcomes of Root replacement group and Subcoronary group are comparable. The material used in right ventricular outflow tract reconstruction should be carefully selected to avoid undesired reoperation.

Key words: Pulmonary Valve, Pulmonary autograft replacement, Ross procedure, Aortic valve disease, Children, adolescent, Reoperation