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Long-term outcomes of Ross procedure in pediatric patients: A single-center experience

Osman Nuri Tuncer¹, Mahsati Akhundova², Reşit Ertürk Levent³, Yüksel Atay<sup>1

1</sup>Department of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Türkiye
²Department of Cardiovascular Surgery, İzmir Tınaztepe University, İzmir, Türkiye
³Department of Pediatric Cardiology, Ege University Faculty of Medicine, İzmir, Türkiye

Keywords: Aortic valve disease, autograft growth, conduit dysfunction, pediatric cardiology, Ross procedure

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Objectives: This study aimed to share a single-center experience with the Ross procedure in pediatric patients and to demonstrate that the need for reoperations due to autograft failure can be minimized with appropriate surgical technique.

Patients and methods: This single-center retrospective study analyzed 18 pediatric patients (16 males, 2 females; median age: 3 years; range, 4 months to 8 years) who underwent the Ross operation between January 2002 and January 2024. Surgical techniques, patient demographics, and outcomes were assessed. Statistical analysis was conducted using the Kaplan-Meier method for overall survival and freedom from reoperation.

Results: Early mortality was 5.5%, primarily due to sepsis and multiple organ failure. The 10-year survival rate was 94%, demonstrating favorable long-term outcomes. Two (11.1%) patients required reoperation for conduit dysfunction, with a 15-year freedom from conduit reintervention rate of 77%.

Conclusion: The Ross procedure in pediatric patients showed low mortality and morbidity rates, with excellent long-term survival outcomes. Effective surgical techniques and modifications were crucial in preventing autograft dysfunction and reducing reoperation rates. The study challenges the notion that the Ross procedure leads to the development of two valve diseases, emphasizing its significance as a preferred option for aortic valve replacement in children.

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