Midterm outcomes and predictors of reintervention after the Ross procedure in infants, children, and young adults

Pasquali, Sara K.; Shera, David; Wernovsky, Gil; Cohen, Meryl S.; Tabbutt, Sarah; Nicolson, Susan C.; Spray, Thomas L.; Marino, Bradley S.

doi:10.1016/j.jtcvs.2006.12.006

Cited by 87 publications

(85 citation statements)

References 30 publications

(50 reference statements)

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“…Thirty-nine publications were included: 17 consecutive series with both children and adults [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] (nϭ2610; 11 604 patient years); 12 adult patient series 20 -31 (nϭ1749; 7458 patientϭyears); and 10 pediatric patient series [32][33][34][35][36][37][38][39][40][41] (nϭ672; 3374 patient-years). Table 1 provides an overview of the publications obtained by the systematic review.…”

Section: Resultsmentioning

confidence: 99%

The Ross Procedure

et al. 2009

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Background-Reports on outcome after the Ross procedure are limited by small study size and show variable durability results. A systematic review of evidence on outcome after the Ross procedure may improve insight into outcome and potential determinants. Methods and Results-A systematic review of reports published from January 2000 to January 2008 on outcome after the Ross procedure was undertaken. Thirty-nine articles meeting the inclusion criteria were allocated to 3 categories: (1) consecutive series, (2) adult patient series, and (3) pediatric patient series. With the use of an inverse variance approach, pooled morbidity and mortality rates were obtained. Pooled early mortality for consecutive, adult, and pediatric patients series was 3.0% (95% confidence interval [CI], 1.8 to 4.9), 3.2% (95% CI, 1.5 to 6.6), and 4.2% (95% CI, 1.4 to 11.5). Autograft deterioration rates were 1.15% (95% CI, 1.06 to 2.06), 0.78% (95% CI, 0.43 to 1.40), and 1.38%/patient-year (95% CI, 0.68 to 2.80), respectively, and for right ventricular outflow tract conduit were 0.91% (95% CI, 0.56 to 1.47), 0.55% (95% CI, 0.26 to 1.17), and 1.60%/patient-year (95% CI, 0.84 to 3.05), respectively. For studies with mean patient age Ͼ18 years versus mean patient age Յ18 years, pooled autograft and right ventricular outflow tract deterioration rates were 1.14% (95% CI, 0.83 to 1.57) versus 1.69% (95% CI, 1.02 to 2.79) and 0.65% (95% CI, 0.41 to 1.02) versus 1.66%/patient-year (95% CI, 0.98 to 2.82), respectively. Conclusions-The Ross procedure provides satisfactory results for both children and young adults.

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Section: Resultsmentioning

confidence: 99%

The Ross Procedure

et al. 2009

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“…Recent reports estimate that nearly 25% of Ross procedures will fail within 20 years when performed in children (a time-frame that our current cohort cannot explore). Aortic root dilatation and recurrent AI account for the majority of these reinterventions [3,18,19]. Ross procedures are generally considered to be susceptible to LVOT dilatation in certain children.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary homograft reoperation is also an important limitation for Ross procedures; especially when performed in very young children [18]. Unlike autografts, pulmonary homografts do not allow for continued conduit growth, and furthermore will gradually calcify.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve repair for insufficiency in older children offers unpredictable durability that may not be advantageous over a primary Ross operation

Wilder

Caldarone

Arsdell

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES:To evaluate the durability of aortic valve (AoV) repair relative to other strategies for children with significant aortic insufficiency (AI). METHODS:From 2001 to 2012, 90 children with greater than or equal to moderate AI underwent surgery. Resulting procedures were classified according to final operative outcome: AoV repair (repair; n = 46, 51%), Ross procedure (Ross; n = 21, 23%) or replacement with mechanical or tissue prosthesis [aortic valve replacement (AVR); n = 23, 26%]. Repeated measures (n = 1081 echocardiograms) mixedmodel analysis and parametric multiphase risk-adjusted hazard analysis were used to evaluate haemodynamic parameters and durability of operations.RESULTS: Mean age at operation was similar for repair and Ross groups, but slightly higher for the AVR group (10.6, 11 and 13.2, respectively; P = 0.04). Baseline annular dimensions were similar among groups. Of 46 repairs, 85% involved pericardial leaflet extensions (commonly with leaflet shaving and/or commisuroplasty). The remaining repairs were commissuroplasties. On multivariable analysis, repair was associated with increased early ( 1-2 years) AI and increased outflow tract peak pressure gradients relative to Ross and AVR procedures. On univariate analysis, repairs tended to have a larger annulus size compared with Ross or AVR; however, this was not significant on multivariable analysis. There were 25 reinterventions (surgical reoperation = 16; transcatheter intervention = 9) for 22 children. Freedom from surgical reoperation was 64, 100 and 51% at 6 years for repairs, Ross and AVR, respectively (P = 0.05); however, three of five reoperations after AVR were for failed bioprosthetic devices. The freedom from reintervention was not significantly influenced by the type of AoV operation (P = 0.43).CONCLUSIONS: Durability of aortic valve repair for children is limited by recurrence of AI and/or stenosis, often within the first few years. After repair, reoperation should be anticipated within 7 years.

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“…Theoretically, there is a benefit of providing a durable aortic valve replacement that may grow with a child and not require future intervention. However, the exchange of "single-valve disease" for "2-valve disease" and data suggesting that the neoaortic valve requires replacement in 10% to 20% of patients within 10 years of operation 27,28 may argue that the long-term outcomes offset the potential benefit. This is a particularly important decision in the case of an unstable patient who may not tolerate the additional bypass time necessary to successfully perform a Ross repair.…”

Section: Circulation June 30 2009mentioning

confidence: 99%