Objective: Aortic valve repair techniques have evolved over the years. However the Ross operation has been considered to be the best option in small children despite some drawbacks. In the last two years we have adopted a more aggressive approach for valve repair with a consequent delay or avoidance of the Ross procedure in many cases.
Methods and Results: between 1993 and 2006 more than 200 patients have been operated on for aortic valve disease, using commissurotomy(29 patients 2 dd-1 yy) or Ross procedures(172 patients, 3 dd-59 yy). During the last 2 years the Ross procedure has been replaced by aortic valve repair in patients with normal or large annulus, using cusps extension(9 patients), annulus plication(2 patients), commissures resuspension(3 patients). During this period the Ross procedure associated to the Konno modification has been applied only to patients with hypoplastic aortic annulus or LVOTO
Comment: New surgical options for children with aortic valve disease have changed our policy in the management of aortic valve. The Ross procedure is now our golden standard for neonates and children with an hypoplastic aortic annulus or as a fall back in cases of failed repair. In the others, aortic valve repair has become our first choice. In the last 2 years we widely applied cusps extension, cusps resuspension, annulus plication in this subset of aortic anatomy with good early and medium term results. A longer follow up will be necessary to have a better understanding of the validity of the aortic valve repair.