The Ross/Ross-Konno procedure in infancy is a safe and durable solution for aortic stenosis

The Ross and Ross-Konno Operation in Neonates and Infants

“…Historically, neonatal and infant Ross-Konno has been avoided because of the high perioperative mortality associated with the procedure, reported in registry data (~ 18% rising to 33% in those requiring concomitant aortic arch repair 9 ). However, results have markedly improved, with many centers reporting good early survival and pleasing mid-term outcomes 10,[12][13][14] . In appropriate patients, the superiority of the autograft valve over alternatives, including repaired aortic valves, has an important benefit in the growing child with a wide and straight left ventricular outflow.…”

“…Mild compromise in cardiac output over the first 24 hours can be anticipated and managed in the usual way for patients with two ventricles. In situations where the ventricular function is poor, despite an apparently good technical result, a planned period of support on ECMO initiated in the operating room is superior to severe low cardiac output syndrome and sequelae, particularly the requirement for emergent cannulation 10 .…”

“…The long-term performance of the autograft and interventions required across the lifespan for a neonate requiring intervention on the aortic remains a concern. Whereas in older patients, the primary shortcoming of the Ross is a relatively high requirement for autograft reinterventions due to dilatation of the neoaortic root and the development of aortic valve incompetence, autografts placed in neonates and infants seem to be less affected by this issue 10,12,18 . The median follow-up times in most reported series are between 3 and 8 years, during which the neo-aortic root demonstrates proportional somatic growth without excessive dilatation.…”

“…Right-sided interventions are an important source of re-intervention. Although the Ross procedure places a homograft in an orthotopic position which is associated with excellent longterm freedom from reoperation on the right side in adults 20 , somatic growth in neonates and infants will necessitate replacement usually within ten years 10 . The developing utility of percutaneous valves may reduce the number of operations required; however, not all conduits are suitable, and the proximity of the left coronary artery to the posterior aspect of the original conduit may cause significant coronary artery compression.…”

Invited Commentary: What Is the Significance of the Konno Incision in Pediatric Ross Procedures?

“…Although this remains to be proven, very low rates of autograft reintervention have been demonstrated following the Ross procedure in infants and neonates. 7 The Ross-Konno procedure carries the advantage of ensuring that the autograft is deeply seated in the native aortic valve annulus and the Konno incision thereby provides annular support and potentially mitigates the risk of autograft annular dilatation over time.…”