ArticleEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2025
Optimized outcome of the Ross procedure in children: single-centre experience†.
Article in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- The Ross Operation in Children-What Is the Long-Term Fate of the Autograft?Interdisciplinary cardiovascular and thoracic surgery · 2026Article
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11 authors.
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Abstract
objectivesThe Ross procedure with autograft reinforcement has been proposed as a strategy to prevent autograft failure in adults, but outcome data in children during somatic growth remain limited. We investigated long-term outcomes following an individualized autograft reinforcement protocol to evaluate survival and reintervention rates.
methodsBetween January 1995 and December 2022, 233 patients <18 years [median age: 7 (1-13) years] underwent the Ross procedure, including 60 infants (26%). Most frequently free-root autograft implantation without reinforcement was performed (n = 156, 67%). Autograft reinforcement was applied in 77 patients (33%) using either subcoronary implantation (n = 65, 28%) or external prosthetic support (n = 12, 5%). Kaplan-Meier survival estimates were used for survival and reintervention analyses. Risk factors for reintervention were identified by Cox proportional hazards regression.
resultsReinforcement was associated with improved survival (5-year survival rates of 97.1% vs 87.0%, 10-year survival rates of 97.1% versus 86.99%, P = 0.017). No differences in autograft reintervention between the groups were found (1-year rates of 100% vs 99.4%, 5-year rates of 100%, P = 0.4852). Right ventricle-pulmonary artery (RV-PA) reintervention-free survival at 5 years was higher for homografts compared to xenografts (96.9% vs 79.4%, P < 0.001).
conclusionsThe Ross procedure in children demonstrated excellent long-term outcomes with low autograft reintervention rates in both groups. Reinforcement was associated with improved long-term survival while autograft-related reinterventions did not differ significantly between groups. Older age at Ross and homograft use correlated with lower RV-PA reintervention risk. Multicentre evaluation of reinforcement techniques is required to assess the outcome differences observed in this single-centre experience.
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