Growth of the pulmonary autograft after the Ross operation in childhood

Objective: Excellent hemodynamic performance has been demonstrated after aortic valve replacement using the autologous pulmonary valve as described by D. Ross. However, in the pediatric population there is concern in regard to growth of the autograft and late dilatation in the systemic circulation. Methods: Since 1991, 30 children (mean age, 11.3 +/- 3.1 years) had aortic valve replacement with the pulmonary autograft as a Not replacement. All children had yearly clinical and echocardiographic follow-up. Results: Then were no perioperative deaths; one child died late in a car accident. At the last follow-up (mean follow-up, 4.3 +/- 2.6 years), all patients: were in NYHA class I. There was one early reoperation, in which the autograft had to be reconstructed due to a leaflet perforation. There were no major valve related events. All children showed normal somatic growth. The annulus diameter increased significantly from 18 +/- 2 at surgery to 20 +/- 3.5 mm at the latest follow-up (P < 0.004). The sinus also increased significantly in diameter from 29 +/- 4 at surgery to 34 +/- 2 mm at the last follow-up (P < 0.001). This increase in autograft size, both for the annulus and the sinus, paralleled the increase in body surface area with no evidence for unproportional dilatation. Hemodynamic measurements demonstrated physiological peak gradients of 6.8 +/- 2.9 mmHg and no or trivial aortic insufficiency in 95% of this rapidly growing patient population. Conclusion: These data demonstrate growth of the pulmonary autograft parallel to somatic growth without undue dilatation in the systemic circulation. The hemodynamics are excellent with regard to physiological gradients and no increase in aortic insufficiency. (C) 2001 Elsevier Science B.V. All rights reserved.