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Mid-term Outcome of 100 Consecutive Ross Procedures: Excellent Survival, But Yet to Be a Cure

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Abstract

The Ross procedure offers excellent short-term outcome but the long-term durability is under debate. Reinterventions and follow-up of 100 consecutive patients undergoing Ross Procedure at our centre (1993–2011) were analysed. Follow-up was available for 96 patients (97%) with a median duration of 5.3 (0.1–17.1) years. Median age of the patient cohort was 15.2 (0.04–58.4) years with 76 males. 93% had underlying congenital aortic stenosis. Root replacement technique was applied in all. The most common valved conduits used for reconstruction of the right ventricular outflow tract were homografts (66 patients) and bovine jugular vein (ContegraR) graft (31 patients). Additional procedures included Ross–Konno procedure (14%), resection of subaortic stenosis/myectomy (11%) and reduction plasty of the ascending aorta (25%). One patient died within the first 30 days (1%). Late deaths occurred in 4 patients (4%) 0.5–4.5 years postoperatively: causes included pulmonary hypertension due to endocardial fibroelastosis (2), subarachnoid haemorrhage (1) and sudden cardiac death (1). Five-year survival was 93.6 (95% CI 88.1–99.1)%. Moderate or severe aortic (autograft) regurgitation needing reoperation occurred in 8 patients with a 5-year freedom from autograft reoperation of 98.5 (95.6–100)%. Five-year freedom from reintervention (surgery or catheter based) on the right ventricular outflow tract conduit was 91.5 (85.5–96.5)%. Univariate predictors of this reinterventions were smaller graft size (p = 0.03) and use of a ContegraR graft (p = 0.04). Ross procedure can be performed with low mortality and good survival in the long term. Most of the reinterventions are related to the neo-right ventricular outflow tract and may be partly attributed to the lack of growth. While the Ross Procedure remains an invaluable option for aortic valve disease in children, new solutions for the neo-pulmonary valve as well as for the less often occurring problems on the autograft are needed.

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Author notes

  1. Hitendu Hasmukhlal Dave and Roland Weber authors share the last authorship of this manuscript.

Authors and Affiliations

  1. Pediatric Heart Centre, University Children’s Hospital Zurich, Zurich, Switzerland

    Corina Zimmermann, Emanuela Valsangiacomo Büchel, Oliver Kretschmar & Roland Weber

  2. The Cardiovascular Center, Klinik Im Park, Zurich, Switzerland

    Christine Attenhofer Jost

  3. Division of Congenital Cardiovascular Surgery, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    René Prêtre, Christoph Mueller & Hitendu Hasmukhlal Dave

  4. Division of Cardiology, University Hospital Zurich, Zurich, Switzerland

    Matthias Greutmann

  5. Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

    Burkhardt Seifert

  6. Children’s Research Centre, University of Zurich, Zurich, Switzerland

    Corina Zimmermann, René Prêtre, Christoph Mueller, Emanuela Valsangiacomo Büchel, Oliver Kretschmar, Hitendu Hasmukhlal Dave & Roland Weber

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  1. Corina Zimmermann
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Contributions

All authors were involved in concept, data interpretation and critical review of the text. CZ, CHAJ, MG, HHD and RW were additionally involved in data analysis, interpretation and drafting of the article. BS was involved in statistics, data interpretation and critical review of the text.

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Correspondence to Roland Weber.

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Zimmermann, C., Attenhofer Jost, C., Prêtre, R. et al. Mid-term Outcome of 100 Consecutive Ross Procedures: Excellent Survival, But Yet to Be a Cure. Pediatr Cardiol 39, 595–603 (2018). https://doi.org/10.1007/s00246-017-1798-z

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  • DOI: https://doi.org/10.1007/s00246-017-1798-z

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