RT Journal Article
SR Electronic
T1 Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1954
OP 1959
DO 10.1136/heartjnl-2014-305873
VO 100
IS 24
A1 Giovanni Battista Luciani
A1 Gianluca Lucchese
A1 Adriano Carotti
A1 Gianluca Brancaccio
A1 Piero Abbruzzese
A1 Giuseppe Caianiello
A1 Lorenzo Galletti
A1 Gaetano Domenico Gargiulo
A1 Stefano Maria Marianeschi
A1 Alessandro Mazzucco
A1 Giuseppe Faggian
A1 Bruno Murzi
A1 Carlo Pace Napoleone
A1 Marco Pozzi
A1 Lucio Zannini
A1 Alessandro Frigiola
YR 2014
UL http://heart.bmj.com/content/100/24/1954.abstract
AB Objective Children undergoing Ross operation were expected to have longer autograft, but shorter homograft durability compared with adults. In order to define the outcome in the second decade after Ross operation in children, a nationwide review of 23 years of experience was undertaken. Methods 305 children underwent Ross operation in 11 paediatric units between 1990 and 2012. Age at surgery was 9.4±5.7 years, indication aortic stenosis in 103 patients, regurgitation in 109 and mixed lesion in 93. 116 (38%) patients had prior procedures. Root replacement was performed in 201 patients, inclusion cylinder in 14, subcoronary grafting in 17 and Ross–Konno in 73. Results There were 10 (3.3%) hospital and 12 late deaths (median follow-up 8.7 years). Survival was 93±2% and 89±3% and freedom from any reoperation was 76±3% and 67±6% at 10 and 15 years. 34 children had autograft 37 reoperations (25 replacement, 12 repair): three required transplantation after reoperation. Freedom from autograft reoperation was 86±3% and 75±6% at 10 and 15 years. 32 children had right heart redo procedures, and only 25 (78%) conduit replacements (15-year freedom from replacement, 89±4%). Prior operation (p=0.031), subcoronary implant (p=0.025) and concomitant surgical procedure (p=0.004) were risk factors for left heart reoperation, while infant age (p=0.015) was for right heart. The majority (87%) of late survivors were in NYHA class I, 68% free from medication and six women had pregnancies. Conclusions Despite low hospital risk and satisfactory late survival, paediatric Ross operation bears substantial valve-related morbidity in the first two decades. Contrary to expectation, autograft reoperation is more common than homograft.