Ross operation in pediatric population: impact of surgical timing and the native pulmonary diameter on the outcome.

Background: Aortic valve replacement early in life maybe inevitable at times. Ross operation until present-day remains the favorite surgical option in pediatrics with irreparable aortic valve disease. Nonetheless the necessity for re-operation was always its principal limitation due to aortic valve failure or homograft degeneration. We hereby present our 25 years of experience in pediatric population. Methods: : From August 1994 until June 2018, a total of 157 children below 18 years underwent a Ross operation. This retrospective review aims at assessing long-term outcome likewise risk factors for re-operation after Ross procedure. Results: : Median age was 10.9 years, of which 7 were infants, 79 children and 71 adolescents. Median follow-up was 14 years. Hospital mortality was 0.6%. Freedom from autograft re-operation for children was 96.7% and 94.1% at 10 and 20 years respectively, whereas for adolescents it was 92.6% and 74.9% at 10 and 20 years. For children freedom from homograft re-operation was 92.5%, 83.5% and 56.2% at 10, 15, and 20 years respectively. While for adolescents, it was 96.8%, 91.8%, and 86.7% at 10, 15, and 20 years. Homograft size (p=0.008) and childhood (p=0.05) were risk factors for homograft re-operation. Pulmonary valve diameter >24 mm (p=0.044) and adolescence (p=0.032) were risk factors for autograft re-operation. Conclusions: : Our experience demonstrated excellent early and late survival. Whilst children have preferential outcomes concerning autograft re-operation, those who received a smaller homograft had higher incidences of right-sided re-intervention compared to adolescents. Pulmonary diameter >24mm at surgery was an indicator for future autograft failure.