The Ross Procedure in Children with Congenital Heart Disease

Aortic valve disease accounts for approximately 5% of all congenital heart defects in children. Choosing the optimal valve replacement in this population is challenging, as it must ensure durability, accommodate growth, and minimize the need for long-term anticoagulation. Biological valves do not re...

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Main Authors: Nabil Dib, Nancy Poirier, Ismail Bouhout, Paul Khairy
Format: Article
Language:English
Published: MDPI AG 2025-05-01
Series:Journal of Cardiovascular Development and Disease
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Online Access:https://www.mdpi.com/2308-3425/12/5/186
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author Nabil Dib
Nancy Poirier
Ismail Bouhout
Paul Khairy
author_facet Nabil Dib
Nancy Poirier
Ismail Bouhout
Paul Khairy
author_sort Nabil Dib
collection DOAJ
description Aortic valve disease accounts for approximately 5% of all congenital heart defects in children. Choosing the optimal valve replacement in this population is challenging, as it must ensure durability, accommodate growth, and minimize the need for long-term anticoagulation. Biological valves do not require anticoagulation but lack durability and growth potential, leading to frequent reoperations. Mechanical valves offer longevity but necessitate lifelong anticoagulation and do not grow with the child. Among the available surgical options, the Ross procedure has emerged as a preferred approach due to its favorable hemodynamic performance, growth potential, and freedom from anticoagulation. First described in 1967, this technique involves replacing the diseased aortic valve with a pulmonary autograft and reconstructing the right ventricular outflow tract using a human or non-human valve substitute. Despite its advantages, the procedure is technically demanding, has a considerable learning curve, and transforms a single-valve pathology into a bivalvular condition. This narrative review provides an updated perspective on the Ross procedure in children, focusing on long-term survival, reoperation rates, and the role of percutaneous valve replacement in delaying surgical reintervention. By synthesizing the latest evidence, we aim to clarify the current standing of the Ross procedure as a durable and effective solution for pediatric aortic valve disease.
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spelling doaj-art-322f5ed46b524399bb9ca0a10aa4e9712025-08-20T03:14:35ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-05-0112518610.3390/jcdd12050186The Ross Procedure in Children with Congenital Heart DiseaseNabil Dib0Nancy Poirier1Ismail Bouhout2Paul Khairy3Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, CanadaDivision of Cardiac Surgery, Department of Surgery, Sainte-Justine Hospital, Université de Montréal, Montreal, QC H3T 1C5, CanadaDivision of Cardiac Surgery, Department of Surgery, Sainte-Justine Hospital, Université de Montréal, Montreal, QC H3T 1C5, CanadaDepartment of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, CanadaAortic valve disease accounts for approximately 5% of all congenital heart defects in children. Choosing the optimal valve replacement in this population is challenging, as it must ensure durability, accommodate growth, and minimize the need for long-term anticoagulation. Biological valves do not require anticoagulation but lack durability and growth potential, leading to frequent reoperations. Mechanical valves offer longevity but necessitate lifelong anticoagulation and do not grow with the child. Among the available surgical options, the Ross procedure has emerged as a preferred approach due to its favorable hemodynamic performance, growth potential, and freedom from anticoagulation. First described in 1967, this technique involves replacing the diseased aortic valve with a pulmonary autograft and reconstructing the right ventricular outflow tract using a human or non-human valve substitute. Despite its advantages, the procedure is technically demanding, has a considerable learning curve, and transforms a single-valve pathology into a bivalvular condition. This narrative review provides an updated perspective on the Ross procedure in children, focusing on long-term survival, reoperation rates, and the role of percutaneous valve replacement in delaying surgical reintervention. By synthesizing the latest evidence, we aim to clarify the current standing of the Ross procedure as a durable and effective solution for pediatric aortic valve disease.https://www.mdpi.com/2308-3425/12/5/186aortic valve diseaseRoss procedurecongenital heart diseasepediatric cardiology
spellingShingle Nabil Dib
Nancy Poirier
Ismail Bouhout
Paul Khairy
The Ross Procedure in Children with Congenital Heart Disease
Journal of Cardiovascular Development and Disease
aortic valve disease
Ross procedure
congenital heart disease
pediatric cardiology
title The Ross Procedure in Children with Congenital Heart Disease
title_full The Ross Procedure in Children with Congenital Heart Disease
title_fullStr The Ross Procedure in Children with Congenital Heart Disease
title_full_unstemmed The Ross Procedure in Children with Congenital Heart Disease
title_short The Ross Procedure in Children with Congenital Heart Disease
title_sort ross procedure in children with congenital heart disease
topic aortic valve disease
Ross procedure
congenital heart disease
pediatric cardiology
url https://www.mdpi.com/2308-3425/12/5/186
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