[Role of the Ross-procedure in the management of congenital heart defects].

Abstract

INTRODUCTION:

The surgical strategy to manage multilevel left ventricular outflow tract diseases is changing constantly, however, the Ross-procedure has remained a standard method for 45 years.

AIM:

The aim of the study was to analyze early and mid-term results of Ross-procedure in congenital heart defects (single surgeon's results).

METHODS:

From 2001 until 2011 a total of 63 patients (age, 28 days-21 years; mean: 10 years, weight 3.4-96 kg; mean, 8.8 kg) underwent Ross (n = 40), Ross-Konno (n = 17) or Ross-Konno-mitral (n = 6) procedures. Indication for Ross procedure was aortic regurgitation in 15 patients (associated with ventricular septum defect in 8 patients) and a predominant aortic stenosis in 25 patients. 17 patients with severe left ventricular outflow tract obstruction underwent Ross-Konno procedure. 6 patients with concomitant mitral valve disease (Shone syndrome, 3 patients; complete atrioventricular septal defect, 3 patients) were reconstructed by Ross-Konno-mitral valve procedure.

RESULTS:

Among Ross patients there were one early (cerebral complication) and one late death (homograft endocarditis) with a mean follow-up time of 7.4±1.8 years. Because of an early autograft endocarditis a 3-year-old boy underwent homograft implantation and was treated successfully with Bentall-procedure 9 years later. One patient with autograft regurgitation is waiting for reoperation. Among Ross-Konno patients there was no early or late death, and none of the patients underwent reoperation. In Ross-Konno-mitral patients there was one early death (28-day-old boy) and during a mean follow-up time of 2.5±1 years, and no reintervention or reoperation was needed in 5 patients.

CONCLUSIONS:

The results indicate a good outcome of Ross-, Ross-Konno-, Ross-Konno-mitral procedures in patients with congenital heart defects when surgery is performed by a highly experienced heart surgeon. In newborns, infants and small children Ross- and Ross-Konno procedures are the only methods for managing left ventricular outflow tract diseases. Concomitant severe mitral disease adds a high level of technical complexity to the Ross-Konno/mitral procedure, but it should be balanced against alternative strategies (eg. single ventricle palliation or transplantation).

• Authors: István Hartyánszky, András Kollár, Krisztina Kádár, László Ablonczy, Edit Novák, Attila Tóth
• Journal: Orvosi hetilap (Orv Hetil) Vol. 154 Issue 6 Pg. 219-24 (Feb 10 2013) ISSN: 0030-6002 [Print] Hungary
• Vernacular Title: A Ross-műtét helye a veleszületett szívhibák sebészi kezelésében.
• PMID: 23376689 (Publication Type: English Abstract, Journal Article)

Topics

• Adolescent
• Aortic Valve (surgery)
• Cardiac Surgical Procedures (methods, mortality)
• Child
• Child, Preschool
• Female
• Heart Defects, Congenital (mortality, physiopathology, surgery)
• Heart Valve Prosthesis
• Heart Valve Prosthesis Implantation
• Hemodynamics
• Humans
• Infant
• Male
• Mitral Valve (surgery)
• Pulmonary Valve (surgery, transplantation)
• Reoperation
• Transplantation, Autologous
• Transplantation, Homologous
• Treatment Outcome
• Ventricular Outflow Obstruction (surgery)
• Young Adult