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J Thorac Cardiovasc Surg. 2014 Jan;147(1):383-8. doi: 10.1016/j.jtcvs.2013.02.037. Epub 2013 Mar 13.

The Ross procedure in patients aged less than 18 years: the midterm results.

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Department of Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy. Electronic address:
Department of Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.



This study reviews a single-center experience with the Ross procedure in infants and young children.


From November 1993 to March 2012, 55 children aged less than 17 years underwent a Ross procedure. The patients ranged in age from 2 days to 17 years (median, 5.9 years). Thirteen patients were infants, and 18 patients were preschool children. The predominant indication for the Ross procedure was aortic stenosis. Twenty-seven patients (49%) with left ventricular outflow tract obstruction underwent a modified Ross-Konno procedure. Twenty-five patients (45%) had undergone 40 previous cardiac procedures. Preoperatively, 3 patients showed severe left ventricular dysfunction, with 2 of the patients requiring intubation and inotropic support. Concomitant procedures were performed in 11 patients (20%). Nine patients underwent mitral valve surgery, and 2 patients underwent subaortic membrane resection.


Patients were followed up for a median of 66 months (range, 3 months to 17 years). Overall survival at 1, 2, 5, and 10 years was 84.9%. Hospital mortality rate was 13% (7/55 patients). All deaths occurred in neonates or infants, except 1 who was aged less than 4 years. Freedom from reoperation for autograft failure was 100% at 1 year, 96.7% at 5 years, and 73.7% at 10 years. During follow-up, 7 patients required a reoperation on the autograft for dilatation and severe aortic insufficiency. Freedom from reoperation for the right ventricular outflow tract replacement was 56.1% at 10 years.


The low rate of autograft failure demonstrates that the Ross procedure is an attractive option for the management of aortic valve disease and complex left ventricular outflow tract obstruction in the pediatric population. However, alternative options must be considered in adolescents and young adults.


20; 26; 35; CI; LVOT; RV-PA; RVOT; confidence interval; left ventricular outflow tract; right ventricle to pulmonary artery; right ventricular outflow tract

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