Perspective:

Aortic valve disease that requires intervention in children continues to present a therapeutic challenge. This study assessed the differences in outcomes in infants and children undergoing primary Ross procedure as compared with those undergoing secondary Ross procedure performed after surgical aortic valve repair. Patients undergoing a secondary Ross procedure generally did better in terms of long-term survival and re-intervention rates. This center is highly experienced both in aortic valve repair and in the Ross procedure. Importantly, the center’s approach has historically been aortic valve repair as the initial “palliative” procedure over transcatheter aortic valvuloplasty. This may limit generalizability of the study to centers with significantly different approaches. The primary limitation of the study is lack of randomization and retrospective design, leaving room for introduction of bias by unidentified variables. Additionally, long-term outcomes for the Ross procedure may be dependent on techniques to stabilize the autograft and present aortic dilatation. In the final years of this study, the authors favored use of a poly-(p-dioxanone) (PDS) band to support the sinotubular junction.