Short- to mid-term outcomes of aortic valve plasty versus Ross procedure in children with severe aortic valve disease: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Lin , WU Zhuheng , LIU Jingyu ,  DIAN Ke

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

DIAN Ke, Email: pangzai356249@126.com

Keywords：

Aortic valve plasty; Ross procedure; children; short- to mid-term outcomes

DOI：

10.7507/1007-4848.202405003

Video：

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Objective To compare the short- to mid-term outcomes of aortic valve plasty (AVP) and Ross surgery in children with severe aortic valve disease. Methods The patients (aged<18 years) with severe aortic valve disease who underwent AVP (an AVP group) or Ross surgery (a Ross group) at the Department of Cardiovascular Surgery, West China Hospital from January 2019 to September 2023 were retrospectively included. We compared perioperative and follow-up data between the groups. Results A total of 48 pediatric patients were included, including 28 males and 20 females, with an average age of (9.3±4.5) years. There were 25 patients in the AVP group, and 23 in the Ross group. Leaflet thinning (15/25, 60.0%) and leaflet extension (10/25, 40.0%) were the most common strategies used in the AVP group, while root replacement technique (12/23, 52.2%) and subcoronary technique (10/23, 43.5%) were the most frequently used strategies in the Ross group. There was no in-hospital death. The median follow-up time was 16.0 (7.0, 30.0) months. Peak flow velocity of the aortic valve was higher in the AVP group [2.0 (1.4, 2.9) m/s vs. 1.2 (1.0, 1.5) m/s, P<0.001], while there was no statistical difference in the postoperative aortic valve regurgitation severity between the two groups (P=0.127). During follow-up, the overall reoperation rate and aortic valve reoperation rate were similar between the AVP group and the Ross group (8.0% vs. 13.0%, P=0.922; 8.0% vs. 0.0%, P=0.266). The rate of recurrent aortic valve disease was higher in the AVP group (52.0% vs. 4.3%, P<0.001), while further analysis failed to recognize any risk factors. Conclusion AVP and Ross procedure show similar perioperative safety, survival and reoperation rate. The rate of recurrent aortic valve disease is higher in the AVP group, but further investigations are needed to confirm the causes.

Citation： XIE Lin, WU Zhuheng, LIU Jingyu, DIAN Ke. Short- to mid-term outcomes of aortic valve plasty versus Ross procedure in children with severe aortic valve disease: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(12): 1794-1802. doi: 10.7507/1007-4848.202405003 Copy

1.	Buratto E, Konstantinov IE. Aortic valve surgery in children. J Thorac Cardiovasc Surg, 2020, S0022-5223.
2.	Myers PO, Mokashi SA, Horgan E, et al. Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease. J Thorac Cardiovasc Surg, 2019, 157(1): 329-340.
3.	Ozaki S, Kawase I, Yamashita H, et al. Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg, 2018, 155(6): 2379-2387.
4.	Alsoufi B. Curb your enthusiasm for the Ozaki procedure in small children. Ann Thorac Surg, 2022, 113(1): 378-379.
5.	Schlein J, Kaider A, Gabriel H, et al. Aortic valve repair in pediatric patients: 30 years single center experience. Ann Thorac Surg, 2023, 115(3): 656-662.
6.	Ivanov Y, Drury NE, Stickley J, et al. Strategies to minimise need for prosthetic aortic valve replacement in congenital aortic stenosis-value of the ross procedure. Semin Thorac Cardiovasc Surg, 2020, 32(3): 509-519.
7.	Ehrlich T, de Kerchove L, Vojacek J, et al. State-of-the art bicuspid aortic valve repair in 2020. Prog Cardiovasc Dis, 2020, 63(4): 457-464.
8.	Ram D, Bouhout I, Karliova I, et al. Concepts of bicuspid aortic valve repair: A review. Ann Thorac Surg, 2020, 109(4): 999-1006.
9.	Charitos EI, Hanke T, Stierle U, et al. Autograft reinforcement to preserve autograft function after the ross procedure: A report from the german-dutch ross registry. Circulation, 2009, 120(11 Suppl): S146-S154.
10.	Starnes VA, Bowdish ME, Cohen RG, et al. The Ross procedure utilizing the pulmonary autograft inclusion technique in adults. JTCVS Tech, 2021, 10: 372-376.
11.	Sievers HH, Hanke T, Stierle U, et al. A critical reappraisal of the Ross operation: Renaissance of the subcoronary implantation technique? Circulation, 2006, 114(1 Suppl): I504-I511.
12.	Karliova I, Schneider U, Ehrlich T, et al. Results of pericardial patches in tricuspid and bicuspid aortic cusp repair. Ann Thorac Surg, 2020, 109(3): 728-735.
13.	Etnel JR, Elmont LC, Ertekin E, et al. Outcome after aortic valve replacement in children: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2016, 151(1): 143-152.
14.	Wiggins LM, Mimic B, Issitt R, et al. The utility of aortic valve leaflet reconstruction techniques in children and young adults. J Thorac Cardiovasc Surg, 2020, 159(6): 2369-2378.
15.	Sharabiani MT, Dorobantu DM, Mahani AS, et al. Aortic valve replacement and the ross operation in children and young adults. J Am Coll Cardiol, 2016, 67(24): 2858-2870.
16.	Fukushima S, Tesar PJ, Pearse B, et al. Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft. J Thorac Cardiovasc Surg, 2014, 148(1): 65-72.
17.	Bouhout I, Ba P S, El-Hamamsy I, et al. Aortic valve interventions in pediatric patients. Semin Thorac Cardiovasc Surg, 2019, 31(2): 277-287.
18.	Vergnat M, Asfour B, Arenz C, et al. Aortic stenosis of the neonate: A single-center experience. J Thorac Cardiovasc Surg, 2019, 157(1): 318-326.
19.	Baird CW, Cooney B, Chávez M, et al. Congenital aortic and truncal valve reconstruction using the Ozaki technique: Short-term clinical results. J Thorac Cardiovasc Surg, 2021, 161(5): 1567-1577.
20.	Zhu MZL, Konstantinov IE, Wu DM, et al. Aortic valve repair versus the Ross procedure in children. J Thorac Cardiovasc Surg, 2023, 166(5): 1279-1288.
21.	Mazine A, David TE, Stoklosa K, et al. Improved outcomes following the Ross procedure compared with bioprosthetic aortic valve replacement. J Am Coll Cardiol, 2022, 79(10): 993-1005.
22.	El-Hamamsy I, Eryigit Z, Stevens LM, et al. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: A randomised controlled trial. Lancet, 2010, 376(9740): 524-531.
23.	Donald JS, Wallace FRO, Naimo PS, et al. Ross operation in children: 23-year experience from a single institution. Ann Thorac Surg, 2020, 109(4): 1251-1259.
24.	Murin P, Weixler VHM, Moulla-Zeghouane J, et al. Subcoronary Ross/Ross-Konno operation in children and young adults: Initial single-centre experience. Eur J Cardiothorac Surg, 2021, 59(1): 226-233.
25.	燕军, 刘鑫荣, 孙彦隽, 等. Ross手术治疗儿童主动脉瓣病变的早期疗效再认识. 中华胸心血管外科杂志, 2021, 37(8): 5.Yan J, Liu XR, Sun YJ, et al. Gold in the dust: The re-evaluation of early surgical results of Ross procedure for aortic valve disease in children. Chin J Thorac Cardiovasc Surg, 2021, 37(8): 5.
26.	Danial P, Neily A, Pontailler M, et al. Ross procedure or complex aortic valve repair using pericardium in children: A real dilemma. J Thorac Cardiovasc Surg, 2022, 163(3): 1180-1191.

1. Buratto E, Konstantinov IE. Aortic valve surgery in children. J Thorac Cardiovasc Surg, 2020, S0022-5223.
2. Myers PO, Mokashi SA, Horgan E, et al. Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease. J Thorac Cardiovasc Surg, 2019, 157(1): 329-340.
3. Ozaki S, Kawase I, Yamashita H, et al. Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg, 2018, 155(6): 2379-2387.
4. Alsoufi B. Curb your enthusiasm for the Ozaki procedure in small children. Ann Thorac Surg, 2022, 113(1): 378-379.
5. Schlein J, Kaider A, Gabriel H, et al. Aortic valve repair in pediatric patients: 30 years single center experience. Ann Thorac Surg, 2023, 115(3): 656-662.
6. Ivanov Y, Drury NE, Stickley J, et al. Strategies to minimise need for prosthetic aortic valve replacement in congenital aortic stenosis-value of the ross procedure. Semin Thorac Cardiovasc Surg, 2020, 32(3): 509-519.
7. Ehrlich T, de Kerchove L, Vojacek J, et al. State-of-the art bicuspid aortic valve repair in 2020. Prog Cardiovasc Dis, 2020, 63(4): 457-464.
8. Ram D, Bouhout I, Karliova I, et al. Concepts of bicuspid aortic valve repair: A review. Ann Thorac Surg, 2020, 109(4): 999-1006.
9. Charitos EI, Hanke T, Stierle U, et al. Autograft reinforcement to preserve autograft function after the ross procedure: A report from the german-dutch ross registry. Circulation, 2009, 120(11 Suppl): S146-S154.
10. Starnes VA, Bowdish ME, Cohen RG, et al. The Ross procedure utilizing the pulmonary autograft inclusion technique in adults. JTCVS Tech, 2021, 10: 372-376.
11. Sievers HH, Hanke T, Stierle U, et al. A critical reappraisal of the Ross operation: Renaissance of the subcoronary implantation technique? Circulation, 2006, 114(1 Suppl): I504-I511.
12. Karliova I, Schneider U, Ehrlich T, et al. Results of pericardial patches in tricuspid and bicuspid aortic cusp repair. Ann Thorac Surg, 2020, 109(3): 728-735.
13. Etnel JR, Elmont LC, Ertekin E, et al. Outcome after aortic valve replacement in children: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2016, 151(1): 143-152.
14. Wiggins LM, Mimic B, Issitt R, et al. The utility of aortic valve leaflet reconstruction techniques in children and young adults. J Thorac Cardiovasc Surg, 2020, 159(6): 2369-2378.
15. Sharabiani MT, Dorobantu DM, Mahani AS, et al. Aortic valve replacement and the ross operation in children and young adults. J Am Coll Cardiol, 2016, 67(24): 2858-2870.
16. Fukushima S, Tesar PJ, Pearse B, et al. Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft. J Thorac Cardiovasc Surg, 2014, 148(1): 65-72.
17. Bouhout I, Ba P S, El-Hamamsy I, et al. Aortic valve interventions in pediatric patients. Semin Thorac Cardiovasc Surg, 2019, 31(2): 277-287.
18. Vergnat M, Asfour B, Arenz C, et al. Aortic stenosis of the neonate: A single-center experience. J Thorac Cardiovasc Surg, 2019, 157(1): 318-326.
19. Baird CW, Cooney B, Chávez M, et al. Congenital aortic and truncal valve reconstruction using the Ozaki technique: Short-term clinical results. J Thorac Cardiovasc Surg, 2021, 161(5): 1567-1577.
20. Zhu MZL, Konstantinov IE, Wu DM, et al. Aortic valve repair versus the Ross procedure in children. J Thorac Cardiovasc Surg, 2023, 166(5): 1279-1288.
21. Mazine A, David TE, Stoklosa K, et al. Improved outcomes following the Ross procedure compared with bioprosthetic aortic valve replacement. J Am Coll Cardiol, 2022, 79(10): 993-1005.
22. El-Hamamsy I, Eryigit Z, Stevens LM, et al. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: A randomised controlled trial. Lancet, 2010, 376(9740): 524-531.
23. Donald JS, Wallace FRO, Naimo PS, et al. Ross operation in children: 23-year experience from a single institution. Ann Thorac Surg, 2020, 109(4): 1251-1259.
24. Murin P, Weixler VHM, Moulla-Zeghouane J, et al. Subcoronary Ross/Ross-Konno operation in children and young adults: Initial single-centre experience. Eur J Cardiothorac Surg, 2021, 59(1): 226-233.
25. 燕军, 刘鑫荣, 孙彦隽, 等. Ross手术治疗儿童主动脉瓣病变的早期疗效再认识. 中华胸心血管外科杂志, 2021, 37(8): 5.Yan J, Liu XR, Sun YJ, et al. Gold in the dust: The re-evaluation of early surgical results of Ross procedure for aortic valve disease in children. Chin J Thorac Cardiovasc Surg, 2021, 37(8): 5.
26. Danial P, Neily A, Pontailler M, et al. Ross procedure or complex aortic valve repair using pericardium in children: A real dilemma. J Thorac Cardiovasc Surg, 2022, 163(3): 1180-1191.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short- to mid-term outcomes of aortic valve plasty versus Ross procedure in children with severe aortic valve disease: A retrospective cohort study

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