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Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry
  1. Giovanni Battista Luciani1,
  2. Gianluca Lucchese1,
  3. Adriano Carotti2,
  4. Gianluca Brancaccio2,
  5. Piero Abbruzzese3,
  6. Giuseppe Caianiello4,
  7. Lorenzo Galletti5,
  8. Gaetano Domenico Gargiulo6,
  9. Stefano Maria Marianeschi7,
  10. Alessandro Mazzucco1,
  11. Giuseppe Faggian1,
  12. Bruno Murzi8,
  13. Carlo Pace Napoleone6,
  14. Marco Pozzi9,
  15. Lucio Zannini10,
  16. Alessandro Frigiola11
  1. 1Department of Surgery, Pediatric Cardiac Surgery Unit, University of Verona, Verona, Italy
  2. 2Bambino Gesù Pediatric Hospital, Rome, Italy
  3. 3Regina Margherita Pediatric Hospital, Turin, Italy
  4. 4Monaldi Hospital, Naples, Italy
  5. 5Department of Cardiac Surgery, Spedali Riuniti, Bergamo, Italy
  6. 6University of Bologna, Bologna, Italy
  7. 7Niguarda Hospital, Milan, Italy
  8. 8Apuano Pediatric Hospital, Massa, Italy
  9. 9Lancisi Hospital, Ancona, Italy
  10. 10Gaslini Pediatric Hospital, Genoa, Italy
  11. 11San Donato Hospital, Milan, Italy
  1. Correspondence to Professor Giovanni Battista Luciani, Division of Cardiac Surgery, Department of Surgery, University of Verona, O. C. M. Piazzale Stefani 1, Verona 37126, Italy; giovanni.luciani{at}


Objective Children undergoing Ross operation were expected to have longer autograft, but shorter homograft durability compared with adults. In order to define the outcome in the second decade after Ross operation in children, a nationwide review of 23 years of experience was undertaken.

Methods 305 children underwent Ross operation in 11 paediatric units between 1990 and 2012. Age at surgery was 9.4±5.7 years, indication aortic stenosis in 103 patients, regurgitation in 109 and mixed lesion in 93. 116 (38%) patients had prior procedures. Root replacement was performed in 201 patients, inclusion cylinder in 14, subcoronary grafting in 17 and Ross–Konno in 73.

Results There were 10 (3.3%) hospital and 12 late deaths (median follow-up 8.7 years). Survival was 93±2% and 89±3% and freedom from any reoperation was 76±3% and 67±6% at 10 and 15 years. 34 children had autograft 37 reoperations (25 replacement, 12 repair): three required transplantation after reoperation. Freedom from autograft reoperation was 86±3% and 75±6% at 10 and 15 years. 32 children had right heart redo procedures, and only 25 (78%) conduit replacements (15-year freedom from replacement, 89±4%). Prior operation (p=0.031), subcoronary implant (p=0.025) and concomitant surgical procedure (p=0.004) were risk factors for left heart reoperation, while infant age (p=0.015) was for right heart. The majority (87%) of late survivors were in NYHA class I, 68% free from medication and six women had pregnancies.

Conclusions Despite low hospital risk and satisfactory late survival, paediatric Ross operation bears substantial valve-related morbidity in the first two decades. Contrary to expectation, autograft reoperation is more common than homograft.

  • Congenital Heart Disease

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