TY - JOUR
T1 - Ross Procedure in Neonates and Infants: A European Multicenter Experience
AU - Mookhoek, Aart
AU - Charitos, Efstratios I.
AU - Hazekamp, Mark G.
AU - Bogers, Ad J.J.C.
AU - Hörer, Jürgen
AU - Lange, Rüdiger
AU - Hetzer, Roland
AU - Sachweh, Joerg S.
AU - Riso, Arlindo
AU - Stierle, Ulrich
AU - Takkenberg, Johanna J.M.
AU - Schoof, Paul H.
N1 - Publisher Copyright:
© 2015 The Society of Thoracic Surgeons
PY - 2015
Y1 - 2015
N2 - Background Infants and neonates with severe left ventricular outflow tract obstruction may require pulmonary autograft replacement of the aortic root. In this retrospective multicenter cohort study, we present our experience with the Ross procedure in neonates and infants with a focus on midterm survival and pulmonary autograft durability. Methods A retrospective observational study was performed in 76 infants (aged less than 1 year) operated on in six congenital cardiac centers in The Netherlands and Germany between 1990 and 2013. Results Patients had a pulmonary autograft replacement of the aortic valve with (68%) or without (32%) septal myectomy. Median patient age was 85 days (range, 6 to 347). Early mortality (n = 13, 17%) was associated with neonatal age, preoperative use of intravenous inotropic drugs, and congenital aortic arch defects. Five patients (9%) died during follow-up. Freedom from autograft reintervention was 98% at 10 years. Echocardiography demonstrated good valve function, with no or trace regurgitation in 73% of patients. Freedom from right ventricular outflow tract reintervention was 51% at 10 years. Univariable analysis demonstrated superior freedom from reintervention of pulmonary homografts compared with aortic homografts or xenografts. Conclusions Pulmonary autograft replacement of the aortic valve in neonates and infants is a high-risk operation but offers a durable neoaortic valve. Midterm durability reflects successful adaptation of the autograft to the systemic circulation. Late mortality associated with heart failure was an unexpected finding.
AB - Background Infants and neonates with severe left ventricular outflow tract obstruction may require pulmonary autograft replacement of the aortic root. In this retrospective multicenter cohort study, we present our experience with the Ross procedure in neonates and infants with a focus on midterm survival and pulmonary autograft durability. Methods A retrospective observational study was performed in 76 infants (aged less than 1 year) operated on in six congenital cardiac centers in The Netherlands and Germany between 1990 and 2013. Results Patients had a pulmonary autograft replacement of the aortic valve with (68%) or without (32%) septal myectomy. Median patient age was 85 days (range, 6 to 347). Early mortality (n = 13, 17%) was associated with neonatal age, preoperative use of intravenous inotropic drugs, and congenital aortic arch defects. Five patients (9%) died during follow-up. Freedom from autograft reintervention was 98% at 10 years. Echocardiography demonstrated good valve function, with no or trace regurgitation in 73% of patients. Freedom from right ventricular outflow tract reintervention was 51% at 10 years. Univariable analysis demonstrated superior freedom from reintervention of pulmonary homografts compared with aortic homografts or xenografts. Conclusions Pulmonary autograft replacement of the aortic valve in neonates and infants is a high-risk operation but offers a durable neoaortic valve. Midterm durability reflects successful adaptation of the autograft to the systemic circulation. Late mortality associated with heart failure was an unexpected finding.
UR - http://www.scopus.com/inward/record.url?scp=84950985005&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2015.08.008
DO - 10.1016/j.athoracsur.2015.08.008
M3 - Journal articles
C2 - 26603019
AN - SCOPUS:84950985005
SN - 0003-4975
VL - 100
SP - 2278
EP - 2284
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -