Twenty-Year Outcome After The Ross Operation in Neonates, Infants and Children: Results From The Italian Pediatric Ross Registry.

Aim. Children undergoing Ross operation were expected to have longer autograft, but shorter homograft durability compared to adults. In order to define the outcome in the second decade after Ross operation in children, a nation-wide review of 23 years of experience was undertaken.Methods and Results. Three-hundred-and-five children underwent Ross operation in 11 Paediatric units between 1990-2012. Age at surgery was 9.4±5.7 years, indication aortic stenosis in 103 patients, regurgitation in 109, mixed lesion in 93. One-hundred-sixteen (38%) patients had prior procedures. Root replacement was performed in 201 patients, inclusion cylinder in 14, sub-coronary grafting in 17, Ross/Konno in 73.There were 10 (3.3%) hospital and 12 late deaths (median follow-up 8.7 years). Survival was 93±2% and 85±8% and freedom from any reoperation was 76±3% and 42±10%, at 10 and 20 years. Thirty-four children had autograft 37 reoperations (25 replacement, 12 repair): 3 required transplantation after reoperation. Freedom from autograft reoperation was 86±3% and 59±10% at 10 and 20 years. Thirty-two children had right-heart redo procedures, only 25 (78%) conduit replacements (20-year freedom from replacement, 77±9%). Prior operation (p=0.031), subcoronary implant (p=0.025), concomitant surgical procedure (p=0.004) were risk factors for left-heart reoperation, while infant age (p=0.015), for right-heart. Majority (87%) of late survivors were in NYHA class I, 68% free from medication and 6 women had pregnancies.Conclusion. Despite low hospital risk and satisfactory late survival, paediatric Ross operation bears substantial valve-related morbidity at 20 years. Contrary to expectation, autograft reoperation is more common than homograft. Further patient selection and modification of operative techniques may decrease valve-related events.