Re-interventions on the autograft and the homograft after the Ross operation in children

Jürgen Hörer*, Ulrich Stierle, Ad J.J.C. Bogers, Joachim G. Rein, Roland Hetzer, Hans H. Sievers, Rüdiger Lange

*Corresponding author for this work
15 Citations (Scopus)


Background: For children who require aortic valve replacement, the pulmonary autograft may be the ideal substitute. However, re-operations for conduit exchange in the pulmonary position are inevitable. In addition, re-operations on the autograft may be necessary due to dilatation and neo-aortic insufficiency. We sought to assess predictors for re-intervention in an international Ross-operated paediatric population. Methods: Data of 152 children below 16 years of age at the time of the Ross operation were analysed using Cox proportional hazard modelling. Mean follow-up time was 6.1 ± 4.2 years. Results: The median age at the time of the Ross operation was 10.1 years (range 54 days to 15 years). Early mortality was 2.6%. Survival at 5 and 10 years was 93.9 ± 2.0% and 90.4 ± 3.1%, respectively. Seven patients required autograft re-intervention (explantation n = 6 and reconstruction n = 1). Freedom from autograft re-intervention at 5 and 10 years was 99.3 ± 0.7% and 95.5 ± 2.7%, respectively. Prior endocarditis (p = 0.061), prior aortic regurgitation (p = 0.061) and longer follow-up time (p = 0.036) emerged as risk factors for autograft re-intervention. Seventeen patients required 36 conduit re-interventions (replacement n = 16, percutaneous valvuloplasty n = 10). Freedom from conduit re-intervention at 5 and 10 years was 89.3 ± 2.9% and 79.6 ± 6.1%, respectively. Implantation of an aortic homograft (p = 0.013), and smaller conduit size (p = 0.074) emerged as risk factors for conduit re-intervention. Conclusions: There is a consistent need for conduit re-intervention following the Ross operation in children. Re-interventions on the autograft are rare within the first decade after surgery. However, the number of autograft re-interventions may increase after the first decade, since longer follow-up time is a risk factor for autograft failure.

Original languageEnglish
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number5
Pages (from-to)1008-1014
Number of pages7
Publication statusPublished - 01.05.2010


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