Journal of Pediatric Cardiology and Cardiac Surgery

The Ross procedure is an excellent option for aortic valve replacement. This double-valve replacement technique is particularly well-suited for neonates, infants, children and adolescents, offering several advantages, including excellent long-term survival, low thrombogenicity, growth potential, and excellent hemodynamic performance. However, the Ross operation proposes disadvantages, such as surgical technical challenges and the future risk of two valve disease from both autograft failure and the necessity for reintervention on the pulmonary allograft. This review aims to examine the contemporary outcomes of the Ross operation in children in our institution over 30 years. Also, insights from other clinical studies with single institutional experiences, multicenter registry data, and expert opinions are synthesized to provide a comprehensive overview of the current state of the Ross procedure. The data were stratified by age to provide more insights into technical, physiological, and outcome differences between infants, children, and adolescents. Although the excellent long-term outcomes after the Ross procedure have been recognized in the young adult population, it remains challenging, especially in infants, due to a higher early mortality rate and the unavoidable need for reintervention for the pulmonary allograft. Continued research, technological innovations, and collaborative efforts among healthcare providers are essential to refine this technique further, ensuring its widespread applicability and improving the quality of life for pediatric patients with aortic valve disorders.