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Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

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Ross-Konno procedure with mitral valve surgery.

Norihiko Oka¹, Osman Al-Radi, Abdullah A Alghamdi

¹Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

The Annals of Thoracic Surgery

|April 27, 2010

Summary

The Ross-Konno procedure effectively treats left ventricular outflow tract obstruction. However, adding mitral valve surgery significantly increases mortality risk in pediatric patients.

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Area of Science:

Pediatric Cardiac Surgery
Congenital Heart Defects
Valvular Heart Disease

Background:

The Ross-Konno procedure addresses complex multilevel left ventricular outflow tract obstruction in infants and children.
Many patients require additional mitral valve surgery, increasing surgical complexity and risk.
This study evaluates outcomes of the Ross-Konno procedure with and without concurrent mitral valve surgery.

Purpose of the Study:

To characterize midterm clinical outcomes of the Ross-Konno procedure.
To compare outcomes between patients undergoing Ross-Konno with mitral valve surgery versus those without.
To assess the impact of concomitant mitral valve procedures on morbidity and mortality.

Main Methods:

Retrospective review of 20 pediatric patients undergoing Ross-Konno procedures between 1995 and 2007.
Patients were divided into two groups: Ross-Konno/Mitral (n=8) and Ross-Konno-nonmitral (n=12).
Midterm clinical outcomes, including survival rates, were analyzed.

Main Results:

The Ross-Konno mitral group (infants) had 3 early and 1 late death, with a 5-year actuarial survival of 43.8%.
The Ross-Konno nonmitral group (older children) had 1 early death, with a 5-year actuarial survival of 91.7%.
Significant differences were observed in age, survival, intubation time, and hospital/ICU stay between the groups.

Conclusions:

The Ross-Konno procedure is effective for multilevel left ventricular outflow tract obstruction in pediatric patients.
Concomitant mitral valve surgery is associated with a significantly higher risk of mortality.
Careful patient selection and risk stratification are crucial for Ross-Konno procedures involving mitral valve intervention.