The Journal of Thoracic and Cardiovascular Surgery
Volume 133, Issue 4 , Pages 893-899, April 2007

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

Presented at the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery 2005 Scientific Session. Dr Pasquali was a Young Investigator Award recipient.

  • Sara K. Pasquali, MD

      Affiliations

    • Division of Cardiology in the Departments of Pediatrics, Surgery, and Anesthesia/Critical Care Medicine at The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • David Shera, ScD

      Affiliations

    • Division of Biostatistics and Epidemiology in the Departments of Pediatrics, Surgery, and Anesthesia/Critical Care Medicine at The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • Gil Wernovsky, MD

      Affiliations

    • Division of Cardiology in the Departments of Pediatrics, Surgery, and Anesthesia/Critical Care Medicine at The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • Meryl S. Cohen, MD

      Affiliations

    • Division of Cardiology in the Departments of Pediatrics, Surgery, and Anesthesia/Critical Care Medicine at The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • Sarah Tabbutt, MD, PhD

      Affiliations

    • Division of Cardiology in the Departments of Pediatrics, Surgery, and Anesthesia/Critical Care Medicine at The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
    • Division of Critical Care Medicine in the Departments of Pediatrics, Surgery, and Anesthesia/Critical Care Medicine at The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • Susan Nicolson, MD

      Affiliations

    • Division of Anesthesia in the Departments of Pediatrics, Surgery, and Anesthesia/Critical Care Medicine at The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • Thomas L. Spray, MD

      Affiliations

    • Division of Cardiothoracic Surgery in the Departments of Pediatrics, Surgery, and Anesthesia/Critical Care Medicine at The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa.
    • ,
  • Bradley S. Marino, MD, MPP, MSCE

      Affiliations

    • Division of Cardiology in the Departments of Pediatrics, Surgery, and Anesthesia/Critical Care Medicine at The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
    • Division of Critical Care Medicine in the Departments of Pediatrics, Surgery, and Anesthesia/Critical Care Medicine at The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
    • Corresponding Author InformationAddress for reprints: Bradley S. Marino, MD, MPP, MSCE, Assistant Professor of Anesthesia and Pediatrics, University of Pennsylvania School of Medicine, The Children’s Hospital of Philadelphia, 7th Floor Main, 34th St. and Civic Center Boulevard, Philadelphia, PA 19104.

Received 13 July 2006; received in revised form 3 October 2006; accepted 18 December 2006.

Objectives

This study assessed the type, time course, and risk factors for right and left ventricular outflow tract reinterventions after the Ross procedure in a population of infants, children, and young adults.

Methods

Patients who underwent the Ross procedure between January 1995 and June 2004 were included (n = 121 consecutive patients). Kaplan–Meier and hazard analyses of right and left ventricular outflow tract reinterventions were performed, and predictors of reintervention were identified through multivariate analysis.

Results

The median age at the Ross procedure was 8.2 years (4 days to 34 years); 20% were aged less than 1 year. Half of the patients had isolated aortic valve disease; the other half had complex left-sided heart disease. Early mortality (<30 days) was 2.5% (n = 3). There were 2 late deaths (1.7%). Follow-up (median 6.5 years [2.5 months to 10.4 years]) was available for 96% of survivors (n = 111). Right ventricular outflow tract reintervention (n = 22 in 15 patients) was performed 2.0 years (2.0 weeks to 9.8 years) after the Ross procedure because of stenosis in 19 of 22 cases. Freedom from right ventricular outflow tract reintervention at 8 years was 81%. Smaller homograft size was the strongest predictor (P < .001) of right ventricular outflow tract reintervention. Left ventricular outflow tract reintervention (n = 15 in 15 patients) was performed 2.8 years (1.0 months to 11.6 years) after the Ross procedure because of severe neoaortic insufficiency in 10 of 15 patients. Freedom from left ventricular outflow tract reintervention at 8 years was 83%. Native pulmonary valve abnormalities (P < .01), original diagnosis of aortic insufficiency (P < .01), prior aortic valve replacement (P = .01), and prior ventricular septal defect repair (P = .04) predicted left ventricular outflow tract reintervention.

Conclusions

At midterm follow-up after the Ross procedure, interim mortality is rare. Neoaortic insufficiency and right ventricle to pulmonary artery conduit obstruction are common postoperative sequelae, requiring reintervention in one quarter of patients.

CTSNet classification: 20, 35

Abbreviations and Acronyms: LVOT, left ventricular outflow tract, RVOT, right ventricular outflow tract, VSD, ventricular septal defect

 

PII: S0022-5223(06)02292-6

doi:10.1016/j.jtcvs.2006.12.006

The Journal of Thoracic and Cardiovascular Surgery
Volume 133, Issue 4 , Pages 893-899, April 2007

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