Subcoronary versus full-root Ross procedure for the pediatric population: an early-to-midterm bicentric experience

With two different Ross autograft implantation techniques: subcoronary vs full-root evolving, the question remains which strategy demonstrates the better early/mid-term performance especially concerning autograft durability. Patients (0-18 years) undergoing Ross procedure from 01/2012-12/2022 in two high-volume centers were included. Patients undergoing both subcoronary and full-root- Ross were analyzed for early mortality, direct postoperative complications as well as 5-year survival, incidence of reinterventions/reoperations, autograft durability over time. Propensity score matching, and regression analysis were used overcoming institutional differences. A total of 205 paediatric patients were included (median age at Ross: 7.6 years [1.9-13.5], 67% males). No differences in baseline characteristics were noted between the groups, except for prior aortic valve repair which occurred more frequently in the full-root-Ross (19 vs 6.9%; p = 0.03). Cardiopulmonary bypass durations (median 265 vs 221 min, p < 0.01), ventilatory support and hospital stay were significant longer in the subcoronary-Ross (p = 0.02) with no differences in any postoperative complications. No differences were noted in 5-year-survival (full-root: 93.3% [87.5-96.5] vs subcoronary: 96.5% [86.6-99.1], p = 0.45), incidence of autograft-reoperations (full-root: 3.2% [1-9.9] vs subcoronary: 2.1% [0.3-14.9], p = 0.98) or incidence of autograft regurgitation ≥ moderate (full-root: 9.8% [5.3-18.2] vs subcoronary: 9.7% [3.1-30.5], p = 0.85) between the groups, also after matching. Independently of the technique, Ross procedure is performed with excellent survival and low autograft reoperation rates in high-volume centers. The longer, technically-more challenging subcoronary-Ross demonstrated no differences in early post-operative complications. A superiority in autograft durability, has so far not been noticed either in the medium-term follow-up.