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Published on: April 1, 2022
Long-Term Survival and Reintervention After the Ross Procedure Across the Pediatric Age Spectrum
Jennifer S Nelson1, Sara K Pasquali2, Clayton N Pratt3
1Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Insights
Long-term outcomes after the Ross procedure in children vary by age. Infants face higher mortality but have durable autografts, while older children require more left ventricular outflow tract reinterventions.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Congenital Heart Disease
Background:
- Limited data exists on long-term outcomes following the Ross procedure in pediatric patients.
- The Ross procedure is a complex cardiac surgery involving aortic valve replacement with a patient's own pulmonary valve.
Purpose of the Study:
- To evaluate long-term mortality and reintervention rates after the Ross procedure in a large pediatric cohort.
- To identify age-specific outcomes and risk factors associated with the procedure.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) who underwent the Ross procedure between 1991 and 2013.
- Kaplan-Meier survival analysis and Cox proportional hazard models were employed to assess long-term outcomes.
Main Results:
- Overall 15-year survival was 87%, with significantly lower survival in infants (72%).
- 15-year freedom from left ventricular outflow tract reintervention was 59%, and from right ventricular outflow tract reintervention was 53%.
- Infants had higher mortality and right ventricular outflow tract reintervention risk, while children/adolescents had higher left ventricular outflow tract reintervention rates.
Conclusions:
- Outcomes of the Ross procedure in children are age-dependent.
- Infants experience higher mortality but excellent autograft durability.
- Children and adolescents face increased risks of left ventricular outflow tract reintervention, whereas infants are at higher risk for right ventricular outflow tract reintervention.
Background:
There are limited data regarding long-term outcomes after the Ross procedure in children. We evaluated mortality and reintervention in a large pediatric cohort.
Methods:
A retrospective analysis of all patients aged younger than 18 years who underwent the Ross procedure at our institution (1991 to 2013) was conducted. Kaplan-Meier curves and Cox proportion hazard models were used to evaluate long-term outcomes and associated risk factors.
Results:
Included were 240 consecutive patients undergoing a Ross/Ross-Konno procedure: 18% infants, 48% children, and 33% adolescents. Infants were more likely to have complex left heart disease (p = 0.005). Overall survival to hospital discharge was 96%; infants had the highest mortality (18%). Long-term survival status was known for 99.6% (median follow-up, 10.7 years). Overall 15-year survival was 87% (lowest in infants, 72%; p = 0.003). Reintervention status was known in 87%. Overall 15-year freedom from any left ventricular outflow tract reintervention was 59%; 85% still had their autograft valve at the latest follow-up. Left ventricular outflow tract reintervention was uncommon in infants (n = 2). Overall 15-year freedom from right ventricular outflow tract reintervention was 53%, and was lower in infants (19%) than in children (51%) and adolescents (76%; p < 0.0001).
Conclusions:
Outcomes after the Ross procedure in children vary by age. Infants more commonly have complex left heart disease and experience higher mortality but have excellent long-term autograft durability. Children and adolescents have higher rates of left ventricular outflow tract reintervention, whereas infants are at highest risk of right ventricular outflow tract reintervention.
