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Ross-konno procedure in children: midterm results
Viktor Hraska1, Christian Lilje, Andrea Kantorová
1German Pediatric Heart Centre, Asklepios Clinic Sankt Augustin, Germany.
Insights
The Ross-Konno procedure shows 96% survival and excellent neoaortic valve function in children with complex left ventricular outflow tract obstruction. Infants experienced higher rates of mitral regurgitation, requiring further investigation.
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.
Abstract:
The aim of this study was to analyze the midterm results following the Ross-Konno procedure in children. Between 1999 and 2008, 29 patients with complex left ventricular outflow tract obstruction underwent the Ross-Konno procedure. There were 12 (41%) infants (group A) and 17 (59%) older patients (group B). The median age at operation was 3.3 years (range, 6 days to 16 years). At 7 years of follow-up, survival was 96% (1 late death), with no differences between groups A and B. Freedom from aortic regurgitation ≥ mild was 81%, with no differences between groups A and B. No residual gradient was noted in the left ventricular outflow tract in either group. Freedom from mitral regurgitation ≥ mild was 100% in group B and 41% in group A (P = .0029). The mitral regurgitation was associated with morphological abnormalities of the mitral valve and with development of endocardial fibroelastosis after failed intervention during the newborn period. Freedom from reoperation was 73% in group B and 24% in group A (P = .0093). All patients are now in sinus rhythm, and 43% are without medication. With the technical aspects of this procedure well accomplished, mortality is low, and the functional outcome is encouraging. At midterm follow-up, there was no residual or recurrent outflow tract obstruction and an excellent function of the neoaortic valve. The higher incidence of mitral regurgitation in infants, which was associated with morphological abnormalities of mitral valve and development of endocardial fibroelastosis, is worrisome.