Twenty-year experience with the Ross-Konno procedure.

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• The Ross-Konno procedure is a complex surgical option for multilevel left ventricular outflow tract obstruction (LVOTO).
• It is often a last resort for patients with multiple prior cardiac surgeries and other anomalies.
• Long-term follow-up data on this procedure are limited.

Purpose of the Study:

• To review a 20-year experience with the Ross-Konno procedure.
• To provide insights into patient outcomes.
• To optimize patient selection for this complex surgery.

Main Methods:

• A retrospective review of 48 patients who underwent the Ross-Konno procedure between 1995 and 2014.
• Analysis of patient demographics, previous surgical history, concomitant procedures, and follow-up data.
• Assessment of early and late mortality, reoperation rates, and autograft function.

Main Results:

• The median follow-up was 4.3 years, with an overall survival of 83% at 5 years and 70% at 15 years.
• Early mortality was 12.5%, with poor left ventricular function identified as a risk factor (P=0.020).
• Reoperation was required in 17 cases, with 5 instances for late autograft failure; freedom from reoperation at 15 years was 30%.

Conclusions:

• The Ross-Konno procedure provides durable relief of multilevel LVOTO in a complex, highly reoperated patient group.
• High early mortality in patients with impaired left ventricular function underscores the need for careful patient selection.
• Continuous attrition from reoperation is observed, with late autograft failure being a possibility.