Aart Mookhoek1, Efstratios I Charitos2, Mark G Hazekamp3, Ad J J C Bogers4, Jürgen Hörer5, Rüdiger Lange5, Roland Hetzer6, Joerg S Sachweh7, Arlindo Riso7, Ulrich Stierle2, Johanna J M Takkenberg4, Paul H Schoof8. 1. Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. Electronic address: a.mookhoek@erasmusmc.nl. 2. Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany. 3. Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands. 4. Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. 5. Department of Cardiovascular Surgery, German Heart Center, Munich, Germany. 6. Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany. 7. Department of Congenital Heart Surgery, University Heart Center, Hamburg, Germany. 8. Department of Pediatric Cardiothoracic Surgery, Utrecht University Medical Center, Utrecht, Netherlands.
Abstract
BACKGROUND: Infants and neonates with severe left ventricular outflow tract obstruction may require pulmonary autograft replacement of the aortic root. In this retrospective multicenter cohort study, we present our experience with the Ross procedure in neonates and infants with a focus on midterm survival and pulmonary autograft durability. METHODS: A retrospective observational study was performed in 76 infants (aged less than 1 year) operated on in six congenital cardiac centers in The Netherlands and Germany between 1990 and 2013. RESULTS: Patients had a pulmonary autograft replacement of the aortic valve with (68%) or without (32%) septal myectomy. Median patient age was 85 days (range, 6 to 347). Early mortality (n = 13, 17%) was associated with neonatal age, preoperative use of intravenous inotropic drugs, and congenital aortic arch defects. Five patients (9%) died during follow-up. Freedom from autograft reintervention was 98% at 10 years. Echocardiography demonstrated good valve function, with no or trace regurgitation in 73% of patients. Freedom from right ventricular outflow tract reintervention was 51% at 10 years. Univariable analysis demonstrated superior freedom from reintervention of pulmonary homografts compared with aortic homografts or xenografts. CONCLUSIONS: Pulmonary autograft replacement of the aortic valve in neonates and infants is a high-risk operation but offers a durable neoaortic valve. Midterm durability reflects successful adaptation of the autograft to the systemic circulation. Late mortality associated with heart failure was an unexpected finding.
BACKGROUND:Infants and neonates with severe left ventricular outflow tract obstruction may require pulmonary autograft replacement of the aortic root. In this retrospective multicenter cohort study, we present our experience with the Ross procedure in neonates and infants with a focus on midterm survival and pulmonary autograft durability. METHODS: A retrospective observational study was performed in 76 infants (aged less than 1 year) operated on in six congenital cardiac centers in The Netherlands and Germany between 1990 and 2013. RESULTS:Patients had a pulmonary autograft replacement of the aortic valve with (68%) or without (32%) septal myectomy. Median patient age was 85 days (range, 6 to 347). Early mortality (n = 13, 17%) was associated with neonatal age, preoperative use of intravenous inotropic drugs, and congenital aortic arch defects. Five patients (9%) died during follow-up. Freedom from autograft reintervention was 98% at 10 years. Echocardiography demonstrated good valve function, with no or trace regurgitation in 73% of patients. Freedom from right ventricular outflow tract reintervention was 51% at 10 years. Univariable analysis demonstrated superior freedom from reintervention of pulmonary homografts compared with aortic homografts or xenografts. CONCLUSIONS: Pulmonary autograft replacement of the aortic valve in neonates and infants is a high-risk operation but offers a durable neoaortic valve. Midterm durability reflects successful adaptation of the autograft to the systemic circulation. Late mortality associated with heart failure was an unexpected finding.
Authors: Alexander Horke; Dmitry Bobylev; Murat Avsar; Bart Meyns; Filip Rega; Mark Hazekamp; Michael Huebler; Martin Schmiady; Ioannis Tzanavaros; Robert Cesnjevar; Anatol Ciubotaru; Günther Laufer; Daniel Zimpfer; Ramadan Jashari; Dietmar Boethig; Serghei Cebotari; Philipp Beerbaum; Igor Tudorache; Axel Haverich; Samir Sarikouch Journal: Eur J Cardiothorac Surg Date: 2020-10-01 Impact factor: 4.191