Abstract 16029: Twenty-Year Outcome After the Ross Operation in Neonates, Infants and Children: Results From the Italian Pediatric Ross Registry
Objective: To define current outcome after Ross operation in children a nation-wide multi-center study covering 22 years of experience was undertaken.
Methods: Between 1990-2013, 305 (178 male) patients underwent the Ross operation in 11 Italian Pediatric Cardiac Surgery units. Age at surgery was 9.4±5.7 years (2 days-18 years). Indication was aortic stenosis with or without subaortic stenosis in 103 patients, regurgitation in 109 and mixed lesion in 93. One-hundred-sixteen (38%) patients had prior cardiac operations. Root replacement was performed in 201 patients, inclusion cylinder in 14, sub-coronary grafting in 17 and Ross/Konno in 73.
Results: There were 10 (3.2%) hospital and 12 late deaths, during a median follow-up of 7 years (2 months-22 years). Survival was 93±2% and 85±8% and freedom from any reoperation was 75±3% and 42±10%, at 10 and 20 years respectively. Twenty-two of 34 (65%) left-heart-reoperations were autograft replacement, while 12 had repair. Three patients required heart transplantation early after left-heart-reoperation. Freedom from autograft reoperation was 86±3% and 59±10% at 10 and 20 years, respectively. Thirty-two patients had right-heart reintervention, but only 25 (78%) were conduit replacement (20-year freedom from right heart redo of 70±8%). At multivariable analysis, age younger than one year (p=0.02) and emergent operation (p=0,04) were risk factors for death; prior operation (p=0.01), subcoronary implant (p=0.03) and concomitant surgical procedure (p=0.001), for left-heart reoperation, while age younger than one year (p=0.01), for right-heart. Majority (87%) of late survivors were in NYHA class I, 39% of them were on cardiac medications and 6 women carried out successful pregnancies.
Conclusions: Pediatric Ross operation is associated with low hospital risk and satisfactory late survival and functional status. When performed in infancy, the Ross carries incremental hospital risk and should be delayed whenever feasible. Valve-related reoperation is substantial at 20 years, but contrary to original expectation, more commonly due to autograft than right-heart dysfunction. Further patient selection and modification of operative techniques may improve freedom from valve-related adverse events.
- © 2013 by American Heart Association, Inc.