Neonates and infants who receive a Ross or Ross-Konno operation form a different population from older children and adults who undergo this procedure. We aimed to provide a contemporary reassessment of the procedure in patients younger than 1 year of age.

We conducted a retrospective, observational multicentre study of patients younger than 1 year who underwent a Ross procedure. Clinical data were obtained from hospital records. Survival was analysed with Kaplan-Meier analysis and Cox regression, and reinterventions with competing-risk models.

Eighty-one children underwent a Ross procedure at a median age of 96 days (IQR 38-166) and a median weight of 4.5 kg (IQR 3.4-6.3), with a median follow-up of 3.8 years (IQR 0.6-10) with a maximum follow-up of 18.6 years. There were 23 (28.4%) deaths, with 15 (18%) occurring in-hospital. Ten-year survival was 72.7%. Longer cardiopulmonary bypass times and extracorporeal membrane oxygenation (ECMO) requirement were associated with in-hospital mortality, while younger age showed a borderline association (P = .05). At 10 years, the cumulative incidence of reintervention was 72.6%, mostly due to a high rate of right ventricle to pulmonary artery (RVPA) conduit reintervention (52.2% at 10 years), but with a low pulmonary autograft reintervention rate (7.6% at 10 years).

Outcomes of Ross (-Konno) operations in patients younger than 1 year reflect the high complexity of this population. Early mortality is significant with acceptable long-term survival rates. The pulmonary autograft in aortic position has good durability with few reinterventions, while RVPA conduits have demonstrated a high number of reinterventions.