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Intermediate-term results of the Ross procedure in neonates and infants
Takeshi Shinkawa1, Edward L Bove, Jennifer C Hirsch
1Division of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Insights
The Ross procedure shows good intermediate-term outcomes in neonates and infants, with low mortality and acceptable reoperation rates. Concomitant surgeries increase initial risk but survival remains favorable.
Area of Science:
- Pediatric Cardiac Surgery
- Aortic Valve Replacement
- Congenital Heart Disease Treatment
Background:
- Limited intermediate-term data exists for the Ross procedure in neonates and infants.
- Previous studies focused primarily on short-term outcomes.
Purpose of the Study:
- To review the intermediate-term results of the Ross procedure in neonates and infants.
- To assess patient survival, autograft function, and reoperation rates.
Main Methods:
- Retrospective review of 31 neonates and infants undergoing the Ross procedure (March 1993-June 2008).
- Analysis of patient survival, autograft function, and need for reoperation.
- Median follow-up of 6.0 years.
Main Results:
- Actuarial survival was 76.7% at 5, 10, and 15 years.
- Freedom from autograft reoperation was 95.2% at 5-10 years and 63.5% at 15 years.
- Higher operative risks were observed in patients requiring concomitant arch or mitral valve surgery.
Conclusions:
- The Ross procedure offers good intermediate-term results for neonates and infants.
- Low mortality and acceptable reintervention rates were achieved.
- Conditional survival is good even for high-risk patients with concomitant procedures.
Background:
Although good intermediate-term results for the Ross procedure in adults and older children have been reported, only short-term outcomes of this procedure in neonates and infants have been published. The objective of this study was to review our intermediate-term results of the Ross procedure for neonates and infants.
Methods:
The records of all 31 neonates and infants undergoing a Ross procedure between March 1993 and June 2008 were reviewed. Major study outcomes included patient survival, autograft function, and need for reoperation.
Results:
The median age at the time of operation was 18 days, and median weight was 3.95 kg. Fifteen patients had aortic stenosis with or without insufficiency, 2 patients had isolated severe aortic insufficiency, and 14 patients had aortic stenosis with other left-side heart lesions, such as arch obstruction or mitral valve disease. Twenty-five patients required aortic annular enlargement (Ross-Konno procedure), and 14 required concomitant arch or mitral valve surgery. There were 5 early and 2 late deaths at a median follow-up of 6.0 years (range, 1.1 to 15.4 years). All early deaths were in patients requiring concomitant arch or mitral valve repair. Actuarial survival rate was 76.7% at 5, 10, and 15 years. There were 19 reinterventions, including 2 procedures on the autograft. Overall freedom from reoperation was 59.1% at 5 years and 50.6% at 10 years. Freedom from autograft reoperation was 95.2% at 5 and 10 years and 63.5% at 15 years.
Conclusions:
The Ross procedure for neonates and infants has good intermediate-term results with low mortality and acceptable rates of reintervention. The patients requiring concomitant arch or mitral valve surgery have higher initial operative risks although conditional survival remains good.
