• Jason W Greenberg, Madison Argo, Awais Ashfaq, Jack C Luxford, Andres A Fuentes-Baldemar, Alyssa B Kalustian, S Valeria Pena-Munoz, David J Barron, Luc L Mertens, S Adil Husain, Jeffrey S Heinle, Lauren C Goldie, Yishay Orr, Julian Ayer, Constantine D Mavroudis, Stephanie M Fuller, MoralesDavid L SDLSCincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Garick D Hill, David S Winlaw, and Ross Collaborative.
• Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: jasongreenbergmd@gmail.com.
• J. Thorac. Cardiovasc. Surg. 2024 Jul 5.

ObjectivesFor neonates and infants with aortic valve pathology, the Ross procedure historically has been associated with high rates of morbidity and mortality. Data regarding long-term durability are lacking.MethodsThe international, multi-institutional Ross Collaborative included 6 tertiary care centers. Infants who underwent a Ross operation between 1996 and 2016 (allowing a minimum 5 years of follow-up) were retrospectively identified. Serial echocardiograms were examined to study evolution in neoaortic size and function.ResultsPrimary diagnoses for the 133 patients (n = 30 neonates) included isolated aortic stenosis (14%, n = 19), Shone complex (14%, n = 19), and aortic stenosis plus other (excluding Shone complex; n = 95, 71%), including arch obstruction (n = 55), left ventricular hypoplasia (n = 9), and mitral disease (moderate or greater stenosis or regurgitation, n = 31). At the time of the Ross procedure, median age was 96 days (interquartile range, 36-186), and median weight was 4.4 kg (3.6-6.5). In-hospital mortality occurred in 13 of 133 patients (10%) (4/30 [13%] neonates). Postdischarge mortality occurred in 10 of 120 patients (8%) at a median of 298 days post-Ross. Post-Ross neoaortic dilatation occurred, peaking at 4 to 5 SDs above normal at 2 to 3 years before returning to near-baseline z-score at a median follow-up of 11.5 [6.4-17.4] years. Autograft/left ventricular outflow tract reintervention was required in 5 of 120 patients (4%) at a median of 10.3 [4.1-12.8] years. Freedom from moderate or greater neoaortic regurgitation was 86% at 15 years.ConclusionsNeonates and infants experience excellent postdischarge survival and long-term freedom from autograft reintervention and aortic regurgitation after the Ross. Neoaortic dilatation normalizes in this population in the long-term. Increased consideration should be given to Ross in neonates and infants with aortic valve disease.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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