title: Rhythm and conduction disturbances at midterm follow-up after the ross procedure in infants, children, and young adults.
abstract: BACKGROUND
  To our knowledge, late electrophysiologic outcomes after the Ross procedure have not been described. The purpose of this study was to assess rhythm and conduction disturbances at midterm follow-up after the Ross procedure.
  
  
  METHODS
  A cross-sectional analysis of Ross procedure survivors (January 1, 1995 to December 31, 2005) followed at our institution was performed, including resting and 24-hour ambulatory electrocardiography (Holter monitoring). Rhythm and conduction disturbances were described, and predictors of arrhythmia were identified.
  
  
  RESULTS
  Of 64 eligible patients, 47 (71%) participated. Median age at surgery was 8.7 years (age range, 34 days to 34 years). Twenty-five patients (53%) had isolated aortic valve disease and 22 (47%) had complex left-sided heart disease. At median follow-up of 8.9 years (range, 2.6-11.1 years), 46 patients (98%) exhibited sinus rhythm. Sinus node dysfunction (SND), defined as a pause of 2 seconds or longer or bradycardia for age, was present in 7 patients (15%). Complete heart block requiring a pacemaker occurred in 2 patients (4%). Ventricular tachycardia (VT) was present in 7 patients (15%), including nonsustained VT in 5 patients on Holter monitoring, and sustained VT in 2 patients requiring defibrillator placement. In multivariate analysis, concurrent arch repair at the time of the Ross operation (p = 0.04), longer cross-clamp time at the time of Ross operation (p = 0.04), and right ventricular outflow tract obstruction on follow-up echocardiogram (p = 0.03) were associated with SND. Longer cross-clamp time (p = 0.03) was also associated with VT, along with older age at surgery (p = 0.06 for trend).
  
  
  CONCLUSIONS
  At midterm follow-up after the Ross procedure, rhythm and conduction disturbances occur in one third of patients, including SND in 15%, atrioventricular block in 4%, and VT in 15%. Routine surveillance for late arrhythmias after the Ross procedure is warranted.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Marino
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kaltman
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schissler
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Meryl S
authors.initials: MS
authors.lastname: Cohen
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.forename: Ronn E
authors.initials: RE
authors.lastname: Tanel
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology; D006327:Heart Block / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011664:Pulmonary Valve / Q000637:transplantation*; D012307:Risk Factors; D012804:Sick Sinus Syndrome / Q000000981:diagnostic imaging / Q000209:etiology; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000209:etiology; D014694:Ventricular Outflow Obstruction / Q000601:surgery*