Ross-konno procedure in children: midterm results

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease
• Cardiovascular Surgery

Background:

• Complex left ventricular outflow tract obstruction (LVOTO) in children necessitates advanced surgical interventions.
• The Ross-Konno procedure is a complex reconstructive technique for severe LVOTO.
• Evaluating midterm outcomes is crucial for understanding the long-term efficacy and safety of this procedure in pediatric populations.

Purpose of the Study:

• To analyze the midterm results of the Ross-Konno procedure in pediatric patients with complex LVOTO.
• To compare outcomes between infants and older children undergoing the procedure.
• To assess survival, valve function, and reoperation rates at midterm follow-up.

Main Methods:

• A retrospective analysis of 29 pediatric patients who underwent the Ross-Konno procedure between 1999 and 2008 for complex LVOTO.
• Patients were divided into two groups: infants (Group A) and older children (Group B).
• Midterm follow-up data, including survival, aortic and mitral regurgitation, residual gradients, and reoperation rates, were analyzed.

Main Results:

• Overall survival was 96% at 7 years, with no significant difference between infant and older patient groups.
• Freedom from moderate or severe aortic regurgitation was 81%, with no residual LVOTO gradient.
• Infants (Group A) showed a significantly higher incidence of mitral regurgitation (59%) compared to older children (Group B) (0%, P = .0029), often linked to mitral valve abnormalities and prior endocardial fibroelastosis.
• Freedom from reoperation was significantly lower in infants (24%) compared to older children (73%) (P = .0093).

Conclusions:

• The Ross-Konno procedure offers encouraging midterm functional outcomes and low mortality for complex pediatric LVOTO.
• Excellent neoaortic valve function and absence of residual obstruction were observed.
• The high rate of mitral regurgitation in infants warrants further attention, potentially related to underlying cardiac anomalies and prior interventions.