Dib Nabil, Poirier Nancy, Bouhout Ismail, Khairy Paul
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada.
Division of Cardiac Surgery, Department of Surgery, Haut Leveque Hospital, Université de Bordeaux, 33000 Bordeaux, France.
J Cardiovasc Dev Dis. 2025 May 15;12(5):186. doi: 10.3390/jcdd12050186.
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.
主动脉瓣疾病约占儿童先天性心脏缺陷的5%。在这一人群中选择最佳的瓣膜置换方式具有挑战性，因为这必须确保耐久性、适应生长，并尽量减少长期抗凝的需求。生物瓣膜不需要抗凝，但缺乏耐久性和生长潜力，导致频繁再次手术。机械瓣膜使用寿命长，但需要终身抗凝，且不会随儿童生长。在现有的手术选择中，罗斯手术因其良好的血流动力学性能、生长潜力和无需抗凝而成为一种首选方法。该技术于1967年首次描述，包括用自体肺动脉瓣替换病变的主动脉瓣，并使用人工或非人工瓣膜替代物重建右心室流出道。尽管该手术有诸多优点，但技术要求高，有相当长的学习曲线，且将单瓣膜病变转变为双瓣膜情况。这篇叙述性综述提供了关于儿童罗斯手术的最新观点，重点关注长期生存率、再次手术率以及经皮瓣膜置换在延迟手术再次干预中的作用。通过综合最新证据，我们旨在阐明罗斯手术作为小儿主动脉瓣疾病持久有效解决方案的当前地位。
