Abstract 2633: Intermediate Term Follow-up after Aortoventriculoplasty with Pulmonary Autograft (Ross-Konno Procedure)
Background: The Ross-Konno procedure is increasingly being used for surgical treatment of infants and children with aortic valve disease associated with left ventricular outflow tract obstruction (LVOTO) and/or aortic annular hypoplasia. The potential for growth of the neo-aortic root and the lack of anti-coagulation requirement make the pulmonary autograft an attractive choice for aortic valve replacement in this age group.
Methods: Between 1994 and 2005, 39 patients underwent a modified Ross-Konno procedure at our institution. Surgery consisted of extensive resection of subaortic fibromuscular tissue for LVOT enlargement, aortic annuloplasty for annular enlargement and correction of size mismatch with the pulmonary valve, replacement of the aortic root with a pulmonary autograft and placement of a homograft in the pulmonary position.
Results: There were 2 early post-operative deaths (5%). Twenty patients (age 8 days to 17 years, mean 5.7 ± 4.7 years) had an intermediate term follow-up (range 2–10 years; mean 4.5 ± 2.1 years). No patients had any residual or recurrent LVOTO or autograft stenosis. Two patients (10%) had 2+ autograft regurgitation whereas no patients had 3– 4+ regurgitation. Eleven patients (55%) had 3– 4+ pulmonary homograft regurgitation with one patient requiring homograft replacement. Freedom from re-operation was 95% for the follow-up period. In all patients, left and right ventricular function remained normal. The growth of the autograft paralleled but did not exceed somatic growth. Indexed neo-aortic annular and root size changed from 22 and 33 mm/m2 post-operatively to 19 and 28 mm/m2 at follow-up with average body surface area increasing from 0.58 to 0.9 m2.
Conclusion: In infants and children with aortic valve disease associated with LVOTO, the Ross procedure combined with a modified Konno technique provides optimal relief of LVOTO, excellent durability of the autograft, favorable growth of the neo-aortic annulus and root in parallel with somatic development, low mortality rate and low rate of re-operation. However, the pulmonary homograft has a high degeneration rate, which at intermediate term, appears to be well tolerated and does not influence survival, right ventricular function or the need for re-operation.