BACKGROUND: For children who require aortic valve replacement, the pulmonary autograft may be the ideal substitute. However, re-operations for conduit exchange in the pulmonary position are inevitable. In addition, re-operations on the autograft may be necessary due to dilatation and neo-aortic insufficiency. We sought to assess predictors for re-intervention in an international Ross-operated paediatric population. METHODS: Data of 152 children below 16 years of age at the time of the Ross operation were analysed using Cox proportional hazard modelling. Mean follow-up time was 6.1+/-4.2 years. RESULTS: The median age at the time of the Ross operation was 10.1 years (range 54 days to 15 years). Early mortality was 2.6%. Survival at 5 and 10 years was 93.9+/-2.0% and 90.4+/-3.1%, respectively. Seven patients required autograft re-intervention (explantation n=6 and reconstruction n=1). Freedom from autograft re-intervention at 5 and 10 years was 99.3+/-0.7% and 95.5+/-2.7%, respectively. Prior endocarditis (p=0.061), prior aortic regurgitation (p=0.061) and longer follow-up time (p=0.036) emerged as risk factors for autograft re-intervention. Seventeen patients required 36 conduit re-interventions (replacement n=16, percutaneous valvuloplasty n=10). Freedom from conduit re-intervention at 5 and 10 years was 89.3+/-2.9% and 79.6+/-6.1%, respectively. Implantation of an aortic homograft (p=0.013), and smaller conduit size (p=0.074) emerged as risk factors for conduit re-intervention. CONCLUSIONS: There is a consistent need for conduit re-intervention following the Ross operation in children. Re-interventions on the autograft are rare within the first decade after surgery. However, the number of autograft re-interventions may increase after the first decade, since longer follow-up time is a risk factor for autograft failure. Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
BACKGROUND: For children who require aortic valve replacement, the pulmonary autograft may be the ideal substitute. However, re-operations for conduit exchange in the pulmonary position are inevitable. In addition, re-operations on the autograft may be necessary due to dilatation and neo-aortic insufficiency. We sought to assess predictors for re-intervention in an international Ross-operated paediatric population. METHODS: Data of 152 children below 16 years of age at the time of the Ross operation were analysed using Cox proportional hazard modelling. Mean follow-up time was 6.1+/-4.2 years. RESULTS: The median age at the time of the Ross operation was 10.1 years (range 54 days to 15 years). Early mortality was 2.6%. Survival at 5 and 10 years was 93.9+/-2.0% and 90.4+/-3.1%, respectively. Seven patients required autograft re-intervention (explantation n=6 and reconstruction n=1). Freedom from autograft re-intervention at 5 and 10 years was 99.3+/-0.7% and 95.5+/-2.7%, respectively. Prior endocarditis (p=0.061), prior aortic regurgitation (p=0.061) and longer follow-up time (p=0.036) emerged as risk factors for autograft re-intervention. Seventeen patients required 36 conduit re-interventions (replacement n=16, percutaneous valvuloplasty n=10). Freedom from conduit re-intervention at 5 and 10 years was 89.3+/-2.9% and 79.6+/-6.1%, respectively. Implantation of an aortic homograft (p=0.013), and smaller conduit size (p=0.074) emerged as risk factors for conduit re-intervention. CONCLUSIONS: There is a consistent need for conduit re-intervention following the Ross operation in children. Re-interventions on the autograft are rare within the first decade after surgery. However, the number of autograft re-interventions may increase after the first decade, since longer follow-up time is a risk factor for autograft failure. Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Authors: Angela McBrien; Milind Chaudhari; David S Crossland; Helen Aspey; Alison Heads-Baister; Massimo Griselli; John O'Sullivan; Asif Hasan Journal: Interact Cardiovasc Thorac Surg Date: 2012-02-22
Authors: Sharman P Tan Tanny; Matthew S Yong; Yves d'Udekem; Remi Kowalski; Gavin Wheaton; Luigi D'Orsogna; John C Galati; Christian P Brizard; Igor E Konstantinov Journal: J Am Heart Assoc Date: 2013-04-19 Impact factor: 5.501