Mid-term Outcomes of the Ross II Procedure in Infants and Young Children with Irreparable Mitral Disease

OBJECTIVES: We aimed to summarize the clinical implications and outcomes of the Ross II procedure for infants and young children. METHODS: This study retrospectively reviewed consecutive paediatric patients who underwent Ross II procedure from 2011 to 2022 at Fuwai Hospital. Baseline, operative, postoperative characteristics, and outcomes were summarized. Postoperative all-cause mortality was defined as the primary outcome, and reoperation as the secondary outcome. RESULTS: Ten patients who underwent the Ross II procedure were included in the final analysis, with 2 cases of late mortality and 3 cases of reoperation during a median follow-up of 36 months (range: 3.5 months to 9 years). The median age at surgery was 1.8 years (interquartile range [IQR]: 0.65 to 3.5), and the median mitral annulus diameter was 16 mm (IQR: 15 to 18). Patients who underwent the Ross II procedure experienced a prolonged postoperative course, with a median intensive care unit stay of 11.5 days (IQR: 8.5 to 19.75) and postoperative hospital stay of 24 days (IQR: 20.25 to 34.75). Mitral stenosis emerged as the predominant late complication following the Ross II procedure, affecting 80% patients, as evidenced by the increase in mean gradient 3 years postoperatively compared with discharge. CONCLUSIONS: The Ross II procedure may represent a safe option for infants and young children when prosthetic valves are unavailable, despite the limited growth potential of the pulmonary autograft.