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

Objectives: With 2 different Ross autograft implantation techniques: subcoronary versus full-root evolving, the question remains which strategy demonstrates the better early/mid-term performance, especially concerning autograft durability.

Methods: Patients (0-18 years) undergoing Ross procedure from January 2012 to December 2022 in 2 high-volume centres were included. Patients undergoing both subcoronary and full-root Ross were analysed for early mortality, direct postoperative complications, 5-year survival, incidence of reinterventions/reoperations and autograft durability over time. Propensity score matching and regression analysis were used to overcome institutional differences.

Results: 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 significantly 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) versus subcoronary: 96.5% (86.6-99.1), P = 0.45], incidence of autograft reoperations [full-root: 3.2% (1-9.9) versus subcoronary: 2.1% (0.3-14.9), P = 0.98] or incidence of autograft regurgitation ≥ moderate [full-root: 9.8% (5.3-18.2) versus subcoronary: 9.7% (3.1-30.5), P = 0.85) between the groups, also after matching.

Conclusions: Independent of the technique, Ross procedure is performed with excellent survival and low autograft reoperation rates in high-volume centres. The longer, technically more challenging subcoronary Ross demonstrated no differences in early postoperative complications. A superiority in autograft durability has so far not been noticed either in the medium-term follow-up.