Ross procedure in neonates and infants: A valuable operation with defined limits
John D Cleveland1, Neeraj Bansal2, Winfield J Wells1
1Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif; Heart Institute, Children's Hospital Los Angeles, Los Angeles, Calif.
The Journal of Thoracic and Cardiovascular Surgery
|May 22, 2022
Summary
The Ross procedure is effective for infant heart defects, but younger infants (under 84 days) and those with complex conditions like Shone complex face higher mortality risks. Survivors show good long-term outcomes for left ventricular outflow tract reintervention.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The Ross procedure utilizes autologous tissue for left ventricular outflow tract (LVOT) repair.
- Infants and neonates undergoing the Ross procedure have historically shown the highest mortality rates.
- Understanding risk factors in this specific pediatric cohort is crucial for improving outcomes.
Purpose of the Study:
- To analyze the institutional experience with the Ross procedure in neonates and infants.
- To identify independent predictors of mortality and clinical outcomes in this high-risk patient group.
- To evaluate long-term survival and reintervention rates following the Ross procedure in young children.
Main Methods:
- Retrospective chart review of all neonates and infants undergoing the Ross operation over a 27-year period.
- Statistical analysis including multiple regression and receiver operating characteristic (ROC) analysis to identify mortality predictors.
- Assessment of in-hospital mortality, late mortality, and rates of LVOT and right ventricular outflow tract reintervention.
Main Results:
- Fifty-eight patients (18 neonates) underwent the Ross procedure; 19% experienced in-hospital mortality.
- Younger age (under 84 days), Shone complex, and interrupted aortic arch with ventricular septal defect were independent predictors of mortality.
- Intermediate-term follow-up revealed low rates of LVOT reintervention (6%), but higher rates of right ventricular outflow tract reintervention (55%).
Conclusions:
- The Ross procedure is a viable option for infants with isolated LVOT obstructive disease.
- Infants under 3 months with Shone complex or interrupted aortic arch/ventricular septal defect face significantly higher risks.
- Survivors demonstrate favorable intermediate-term freedom from LVOT reintervention, highlighting the procedure's effectiveness for selected pediatric patients.
