Objective
The Ross operation is the procedure of choice for pediatric patients with irreparable aortic valve disease due to the growth potential of the autograft. However, controversy exists as to whether autograft growth actually occurs.
Methods
Since 1997, 86 patients have undergone the Ross operation at this institution with one early and one late death. This report will focus on the first 10 patients, 16 years or younger (mean age =10.8 years, range 1.2-16) who underwent this procedure. All had echocardiographic follow up. Initial postoperative echocardiograms and the most recent echocardiograms were reviewed. The length of the autograft, maximal length of coaptation of the leaflets and autograft diameter were measured.
Results
There were no perioperative deaths. All patients are alive and in NYHA class I. Median follow up is 48 months. One patient developed progressive AI and required valve replacement. In the remaining patients annular and sinus diameter increased significantly from 17mm and 26mm postoperatively to 22mm and 35mm at last follow up (p=0.009 and p=0.013). Interestingly, autograft length and the maximum length of leaflet coaptation increased significantly from 19mm and 7mm postoperatively to 24mm and 12mm at last follow up (p=0.02 and p=0.001). These increases in autograft diameter and length paralleled increases in BSA.
Conclusion
Growth of the autograft occurs in a longitudinal manner as well as radially, and is accompanied by an increase in the length of the coaptation surface. These findings may account for valvular competency in light of increases in size of the annulus and sinus.

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