Ross-Konno procedure with mitral valve surgery

The Ross-Konno procedure has emerged as a complex procedure to address multilevel left ventricular outflow tract obstruction in infants and small children. Significant proportions of patients, however, have concomitant mitral valve disease and require a mitral procedure in addition to the Ross-Konno procedure. Ross-Konno-mitral surgery puts three valves at risk and may be associated with significant morbidity and mortality and, therefore, we sought to characterize midterm clinical outcomes after the Ross-Konno procedures with and without concomitant mitral valve surgery.

We reviewed medical records of 20 consecutive patients who underwent Ross-Konno/Mitral procedures (n = 8) or Ross-Konno-nonmitral procedures (eg, without mitral valve repair, n = 12) between 1995 and 2007.

In Ross-Konno mitral patients (age 326 +/- 268 days; range, 1 to 817 days), there were 3 early deaths and 1 late death with a mean follow-up of 1.8 +/- 2.5 years. Seven patients had intervention prior to Ross-Konno. Actuarial survival at 5 years was 43.8%. In Ross-Konno nonmitral patients (age, 2,110 +/- 2,020 days; range, 3 to 5,563 days), there was one early death with mean follow-up of 2.7 +/- 2.6 years. Ten patients had intervention prior to Ross-Konno. Actuarial survival at 5 years was 91.7%. There were significant differences between groups in age, survival rate, intubation time, coronary care unit stay, and hospital stay (Ross-Konno mitral vs Ross-Konno nonmitral: 0.89 +/- 0.73 vs 5.8 +/- 5.5 years, 43.8 vs 91.7%, 17.0 +/- 15.7 vs 2.6 +/- 2.7 days, 22.9 +/- 22.7 vs 4.1 +/- 3.1 days and 28.6 +/- 21.2 vs 11.5 +/- 7.1 days).

The Ross-Konno procedure effectively treats multilevel left ventricular outflow tract obstruction in infants and small children. The requirement for concomitant mitral valve surgery, however, is associated with significantly higher likelihood of mortality.