Long-Term Autograft Dilation and Durability After the Ross Procedure are Similar Among Infants, Children, and Adolescents with Primary Aortic Stenosis

OBJECTIVE:Autograft durability and remodeling are thought to be superior in younger pediatric patients after the Ross operation. We sought to delineate the fate of the autograft across the pediatric age spectrum in patients with primary aortic stenosis (AS). METHODS:We retrospectively reviewed patients aged ≤18 years with primary AS who underwent the Ross operation from 1993 to 2020. Patients were categorized by age. The primary endpoint was autograft dimensional change. Secondary endpoints were severe neo-aortic insufficiency (AI) and autograft reintervention. RESULTS:One hundred and nineteen patients underwent the Ross operation, including 37 (31.1%) in group I (<18 months), 24 (20.2%) in group II (18 months-8 years), and 58 (48.7%) in group III (8-18 years). All groups exhibited similar annular growth rates within the first 5 postoperative years, followed by a collective decrease in annulus growth rates from years 5-10. Group III experienced rapid sinus dilation in the first 5 years, followed by stabilization of the sinus z-score from years 5-10; groups I and II demonstrated stable sinus z-scores over 10 years. There were 4 (3.4%) early and 2 (1.7%) late mortalities at a median follow-up of 8.1 years [range: 0.01-26.3]. At 15 years, there was a similar incidence of severe neo-AI (0.0%±0.0% vs. 0.0%±0.0% vs. 3.9%±3.9%, p=0.52) and autograft reintervention (8.4%±6.0% vs. 0.0%±0.0% vs. 2.4%±2.4%, p=0.47) in all groups. CONCLUSIONS:Age at the Ross operation for primary AS does not influence long-term autograft remodeling or durability. Other physiologic or technical factors are likely greater determinants of autograft fate.