Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry

Luciani, Giovanni Battista; Lucchese, Gianluca; Carotti, Adriano; Brancaccio, Gianluca; Abbruzzese, Pietro A.; Caianiello, Giuseppe; Galletti, Lorenzo; Gargiulo, Gaetano; Marianeschi, Stefano; Mazzucco, Alessandro; Faggian, Giuseppe; Murzi, Bruno; Napoleone, Carlo Pace; Pozzi, Marco; Zannini, L.; Frigiola, Alessandro

doi:10.1136/heartjnl-2014-305873

Cited by 61 publications

(50 citation statements)

References 27 publications

(73 reference statements)

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“…Focusing on PC, aortic homografts were employed in the 1960s, followed by porcine xenografts in Dacron fabric tubes in the 1970s. The secondary finding of the study is that freedom from reoperation is significantly lower than that observed in age-matched children having orthotopic HG (7), although in line with results by Tweddell (54% at 10 years) and Brown (43% at 15 years). Between the late 1980s and the 1990s, novel design xenograft conduits became available for clinical use, although late outcomes reported for these conduits were disappointing (8,9).…”

Section: Discussionsupporting

confidence: 84%

“…Indications for replacement of the original PC were conduit stenosis with a gradient greater than 40 mm Hg, RV pressures 75% or more of left ventricular pressure or echocardiographic and MRI evidence of progressive RV dilation or tricuspid valve regurgitation, or both, associated with right heart failure due to PC dysfunction. In order to define outcome of heterotopic PC implantation in infants and children treated at our institution, comparison with data in 305 children and with a median age of 9.4 years, receiving orthotopic PC, either HG (n = 281) or XG (n = 24) between 1990 and 2012 (Italian Pediatric Ross Registry) was undertaken (7).…”

Section: Study Population and Operative Datamentioning

confidence: 99%

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Twenty‐Year Outcome After Right Ventricular Outflow Tract Repair Using Heterotopic Pulmonary Conduits in Infants and Children

et al. 2015

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Durability of pulmonary conduits (PCs) used for reconstruction of the right ventricular outflow tract (RVOT) may be affected by a variety of factors. Among these, the technique used for PC implantation, whether in orthotopic or heterotopic position, strictly dependent upon the underlying anatomy, has been suggested to influence long-term outcome after RVOT repair. To determine the outcome of heterotopic implantation in infants and children treated at our institution, late results of heterotopic PC in non-Ross patients were analyzed and compared with data of orthotopic PC in age-matched pediatric Ross patients operated during the same time period. Between November 1991 and January 2015, 58 infants and children, 32 male and 26 female, with a median age of 9.4 years (range 1 day-18 years) underwent implantation of heterotopic PC (31 homografts [HG] and 27 xenografts [XG]) for reconstruction of RVOT. Median age in the XG group was significantly lower than in the HG group (0.9 vs. 13.4 years, P = 0.01), while male/female ratio was similar. Fifty (86%) patients had undergone one or more prior cardiac operations, while 32 (55%) required associated procedures during PC implantation. Comparison with data in 305 children and with a median age of 9.4 years, receiving orthotopic PC between 1990 and 2012 (Italian Pediatric Ross Registry), was undertaken. Descriptive, univariate, and Kaplan-Meier analysis defined outcome. There were three (5.2%) early and five (9.0%) late deaths, during a median follow-up of 7.6 years (range 2 months-23 years). Patients having XG had trend toward higher hospital mortality (2/27 vs. 1/31, P = 0.2), but similar late mortality (2/24 vs. 3/30, P = 0.3). Overall survival was 88 and 62%, while freedom from PC replacement was 49 and 21%, at 10 and 20 years, respectively. The latter proved significantly worse than freedom from orthotopic PC replacement, which was 94 ± 2 and 70 ± 9% at 10 and 20 years (P = 0.02). When stratified for type of heterotopic PC, late survival proved comparable (81 and 81% for XG vs. 92 and 60% for HG, at 10 and 20 years, respectively, P = 0.7). However, freedom from PC replacement was significantly higher in patients with heterotopic HG (21 and 5% for XG vs. 63 and 48% for HG, at 10 and 20 years, respectively, P = 0.001). RVOT repair using either XG or HG in heterotopic position is a safe procedure associated with low hospital mortality and satisfactory late survival. Freedom from reoperation is significantly lower than that observed in age-matched children having orthotopic HG. Freedom from reoperation in heterotopic XG is poorer than in HG, although different baseline demography may have influenced this finding.

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Section: Discussionsupporting

confidence: 84%

Section: Study Population and Operative Datamentioning

confidence: 99%

Twenty‐Year Outcome After Right Ventricular Outflow Tract Repair Using Heterotopic Pulmonary Conduits in Infants and Children

et al. 2015

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“…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).…”

mentioning

confidence: 81%

“…Children and adolescents have higher rates of left ventricular outflow tract reintervention, whereas infants are at highest risk of right ventricular outflow tract reintervention. T he Ross procedure is commonly used in children requiring aortic valve replacement [1,2]. Advantages include autograft growth potential, excellent flow characteristics, and avoidance of anticoagulation [3,4].…”

mentioning

confidence: 99%

Long-Term Survival and Reintervention After the Ross Procedure Across the Pediatric Age Spectrum

Nelson

Pasquali

Pratt

et al. 2015

The Annals of Thoracic Surgery

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“…To the Editor, We have read the interesting article from Luciani and colleagues1 documenting the outcomes into the second decade after the Ross procedure in infants and children from the Italian Paediatric Ross Registry. The conclusion concisely stated that the Ross procedure was a low-risk palliative procedure for aortic valve abnormalities at the expense of valve-related reoperation.…”

mentioning

confidence: 99%

The role of LV in the autograft complication after ROSS operation

Chen

Li³

2014

Heart

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Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry

Abstract: 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.

Cited by 61 publications

References 27 publications

Twenty‐Year Outcome After Right Ventricular Outflow Tract Repair Using Heterotopic Pulmonary Conduits in Infants and Children

Twenty‐Year Outcome After Right Ventricular Outflow Tract Repair Using Heterotopic Pulmonary Conduits in Infants and Children

Long-Term Survival and Reintervention After the Ross Procedure Across the Pediatric Age Spectrum

The role of LV in the autograft complication after ROSS operation

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