Ross Procedure in Adolescence: Replacement is Better Than Repair, Mostly

• Published in: Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual Vol. 28; pp. 68 - 78
• Main Authors: Robinson, Justin, Winlaw, David S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2025
• Subjects: Adolescent; Aortic Valve - surgery; aortic valve repair; CHD; congenital heart surgery; Heart Valve Prosthesis Implantation - methods; Humans; outcomes; Pulmonary Valve - transplantation; Ross; Treatment Outcome; RV-PA; outcomes; congenital heart surgery; BAV; AI; Ross; AVr; CHD; aortic valve repair; RVOT
• ISSN: 1092-9126
• DOI: 10.1053/j.pcsu.2025.03.005

•Aortic valve repair and Ross offers potential for growth, avoids anticoagulation.•Aortic valve repair avoids coronary reimplantation and extensive root manipulation, reducing operative risk.•Ross procedure generally offers better freedom from reoperation compared to aortic valve repair.•The choice between aortic valve repair and Ross depends on valve morphology, patient age, reoperation risks, and institutional expertise. Individualized approaches optimize long-term outcomes, balancing repair durability with the risks of early replacement. Surgical management of isolated aortic valve pathology in adolescents primarily involves aortic valve repair and the Ross procedure, each with distinct advantages and limitations influenced by anatomical considerations. The optimal surgical strategy in this population remains a subject of ongoing debate, as it must balance the need for future growth potential with the goal of maintaining near-normal hemodynamics while minimizing reinterventions and maximizing survival. Ultimately, the choice of procedure should be tailored to the patient's clinical and anatomical characteristics. Here, we critically examine the existing data on aortic valve repair, with a particular emphasis on the role and outcomes of the Ross procedure in adolescents.