International Panel Discussion（II-IPD）
Management of Aortic Valve in Pediatric Patients

[II-IPD-03] Aortic valve replacement in children: Pulmonary valve autograft (Ross) vs mechanical prosthesis

^○Takaya Hoashi^1,2, Motoki Komori² (1.Department of Pediatric Cardiac Surgery, Saitama Medical University International Medical Center, 2.Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center)

Objective: To compare the long-term surgical outcomes of Ross operation to mechanical aortic valve replacement (mAVR) in children with aortic stenosis. Method: From 1989 to 2015, 79 children underwent AVR. Of those, 27 patients underwent mAVR, and 53 patients underwent Ross procedure. Long-term outcomes were retrospectively compared using inverse probability of treatment weighting. Follow-up was completed in 73% of patients and mean follow-up period of hospital survivors was 15.7 years. Results: Survival, reoperation free survival, and anticoagulation related complications-free survival rates were similar in both groups. Latest cardiac catheterizations at 14 years after the procedure showed better cardiac index in Ross group. Latest echocardiograms at 17 years after the procedure showed more frequent aortic stenosis in mAVR group, whereas moderate or greater pulmonary regurgitation in Ross group. Late NYHA functional status was significantly better in Ross group. Conclusions: Ross procedure provided sufficient total cardiac output and NYHA status. mAVR using small caliber prostheses can be an option in small children, because anticoagulation related complications rarely occurred.