Congenital Heart Surgeons' Society

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A Comparison Of The Ross Procedure And Prosthetic Aortic Valve Replacement In Children And Young Adults With Congenital Aortic Valve Disease In The Current Era
Anna Olds, MD, David Blitzer, Eliana Al Haddad, Brigitte Kazzi, Julie Vincent, Matthew A. Crystal, Alejandro Torres, Damien LaPar, Paul Chai, Emile Bacha, David Kalfa.
Columbia University Medical Center, New York, NY, USA.

Objective(s): The Ross procedure offers a growing valve option for young patients, eliminating anticoagulation, but requiring pulmonary valve replacement. We compare outcomes after Ross and prosthetic aortic valve replacement (pAVR) in young patients with congenital aortic valve (AV) disease.
Methods: We retrospectively reviewed consecutive patients≤35 years old undergoing Ross or pAVR for congenital AV disease (excluding truncus arteriosus) at our institution from 2006-2017. Primary outcomes were mortality and reoperation.
Results: We included 92 AVRs: 60 Ross and 32 pAVR (19 bioprostheses; 13 mechancial prostheses). Table 1 summarizes demographics and outcomes. Ross patients were significantly younger, smaller, with a smaller aortic annulus compared to pAVR patients (all p<0.01). Ross patients had longer bypass (p<0.01) and cross-clamp times (p<0.01). Four Ross patients had postoperative cardiac arrest (vs. 0 pAVR; p=0.29). Length of stay and mortality were similar. Follow-up was 1.9 (0.04-5.6) and 3.1 (1.2-6.4) years for Ross and pAVR, respectively. At last follow-up, Ross patients had significantly less aortic stenosis≥moderate (p<0.01) with similar aortic regurgitation≥moderate (p=0.16). Total reoperation was similar (p=0.43), with 2 Ross and 3 pAVR patients requiring AV reoperation (p=0.33), and 10 Ross requiring conduit replacement.
Conclusions: While technically more challenging, the Ross procedure is a safe, effective AVR alternative in young patients, resulting in significantly less mid-term aortic stenosis than pAVR with no increase in AV reoperation, at the expense of homograft reoperation.

Table 1: Preoperative Details and Postoperative Outcomes
pAVR (n=32)Ross (n=60)P-value
Age (years)16.8±7.18.8±7.6<0.01
Weight at surgery (kg)59.5±24.836.8±29.4<0.01
Aortic annulus (mm)2315<0.01
Bypass time (min)130±49.4182.5±51.5<0.01
Cross-clamp time (min)90.8±31.8122.2±30.5<0.01
Mortality, n (%)1 (3.1)1 (1.7)1.00
AS ≥mod at last follow-up, n (%)6 (18.8)0<0.01
AI ≥mod at last follow-up, n (%)05 (8.3)0.16
LVOT reoperations, n (%)5 (15.6)3 (5.0)0.12