Aortopulmonary size discrepancy is not a contraindication to the pediatric Ross operation

Background. Modification of the aortic annulus or the ascending aorta, or both, may be required in pediatric patients undergoing the Ross operation. The fate of these autografts remains uncertain. Methods. Retrospective review of 15 patients undergoing Ross operation without aortic annular modification (group 1), 11 patients requiring annular reduction (group 2, n = 11), and 8 patients requiring annular enlargement (group 3, n = 8). Autograft function and dimensions were evaluated by echocardiography. Results. Autograft insufficiency was less than or equal to mild in 33 patients and moderate in 1 patient. The annulus body surface area ratio increased in group 1 from 19.7 ± 5 to 20.3 ± 5 mm/m2 (p = 0.8). The average annular reduction in group 2 was 5 ± 1.5 mm, and 10 of 11 patients required reduction of the ascending aorta (mean 11 ± 5 mm). The annulus body surface area ratio increased from 18.6 ± 7 to 20.5 ± 9 mm/m2 (p = 0.2). The mean augmentation in annulus diameter in group 3 was 6 ± 4 mm; the annulus body surface area ratio decreased from 23.7 ± 14 to 20.3 ± 8 mm/m2 (p = 0.5). Conclusions. We continue to offer the Ross operation to pediatric patients even when aortic annular or ascending aortic size discrepancies mandate surgical modifications.