Background and aim of the study: The Ross procedure has become the first choice for aortic valve replacement in children and young adults at many institutions. Since 1997, a lack of availability of homograft valves in Turkey has prompted the use of alternative substitutes for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure.
Methods: Before April 2005, among 20 patients (age range: 14 months to 45 years) at the present authors’ institution, the Ross procedure was performed in 14 and a Ross-Konno procedure in six. Sixteen patients underwent RVOT repair using alternative methods for homograft valve replacement. Fourteen patients received a Medtronic Freestyle valve and one patient a Medtronic Contegra bovine jugular vein conduit. An autologous RVOT repair was used in one patient. Ten of the Medtronic Freestyle valve patients were aged <16 years. In all patients who received a Medtronic Freestyle valve echocardiographic evaluations were conducted shortly after surgery and during follow up.

Results: There was no early mortality. One patient died from pneumonia after six months, and another (asymptomatic) patient died suddenly at 34 months after surgery. Before hospital discharge the mean peak pressure gradient across the Freestyle valve was 12.1 ± 11.0 mmHg, and this increased to 24.1 ± 20.0 mmHg after a mean follow up of 51.2 ± 6.9 months (range: 6 to 101 months) (p <0.002). Mild pulmonary regurgitation was seen in two patients. One asymptomatic adult patient was reoperated on at another center because of a 60-mmHg echocardiographic peak gradient at four years postoperatively.
Conclusion: Although long-term follow up is required to explain the durability of the Medtronic Freestyle valve, the present results show that the valve can be used with intermediate-term success in the Ross procedure - and even in children as an alternative - if homograft valves are not available.

The Journal of Heart Valve Disease 2006;15:696-701