Autograft Wrapping Reinforcement in Adolescents Undergoing Ross Operation: A Tailored Coat

Abstract

Background: The Ross operation is a good surgical option for the pediatric population with aortic valve disease. However, the need for reoperation due to aortic root dilatation remains the principal limitation of this procedure. We report a small series of adolescents who underwent the Ross operation with Gore-Tex (W. L. Gore & Associates, Flagstaff, AZ) membrane reinforcement to avoid the progressive dilatation of the neoaortic root.

Methods: Between March 2002 and March 2010, 15 adolescent patients underwent a modified Ross procedure with the autograft wrapping with 0.1-mm Gore Preclude (W. L. Gore & Associates) pericardial membrane. Follow-up was performed by clinical and echocardiographic controls.

Results: These patients were a mean age of 15 ± 1.4 years. The mean aortic cross-clamp time was 130 ± 17 minutes. The mean cardiopulmonary bypass time was 187 ± 27 minutes. There was no hospital mortality. The mean follow-up was 15 ± 2.5 years (range, 9.7-17.7 years). During the follow-up, 1 patient required aortic valve reoperation for cusps prolapse. The mean diameters of annulus (22.8 ± 1.8 mm vs 23.3 ± 1.5 mm, P = .12), aortic root (27.4 ± 1.4 mm vs 28.2 ± 0.8 mm, P = .09), and sinotubular junction (24.3 ± 1.1 mm vs 25.1 ± 0.7 mm, P = .11) were not statistically different between discharge and follow-up.

Conclusions: The wrapping reinforcement autograft in the Ross procedure with Gore-Tex membrane is simple, safe, and does not require significant additional time. Our results showed good early and long-term outcomes for reoperation, aortic root dilatation, and aortic valve degeneration.