title: Midterm results of the modified Ross/Konno procedure in neonates and infants.
abstract: BACKGROUND
  The management of congenital aortic stenosis in neonates and infants continues to be a surgical challenge. We have performed the modified Ross-Konno procedure for patients who have severe aortic insufficiency or significant residual stenosis after balloon aortic dilation. The midterm results of this procedure were evaluated in this subset of patients.
  
  
  METHODS
  Between 1994 and 2010, a total of 24 patients younger than 1 year of age underwent the modified Ross-Konno procedure. The diagnoses were aortic stenosis with or without subaortic stenosis (n = 16), Shone's complex (n = 7), and interrupted aortic arch with subaortic stenosis (n = 1). The aortic root was replaced with a pulmonary autograft, and the left ventricular outflow tract (LVOT) was enlarged with a right ventricular infundibular free wall muscular extension harvested with the autograft.
  
  
  RESULTS
  Age at operation ranged from 1 to 236 days (median 28 days). The median follow-up period was 81 months (range 1-173 months). There was 1 early death and no late mortality. Overall the 1-, 2-, and 5-year survival rate was 95% ± 4.5%. Freedom from aortic stenosis was 94.7% ± 5.1% at 1, 2, and 5 years. Less than mild aortic insufficiency was 93.3% ± 6.4% at 2 years, and 74.7% ± 12.9% at 5 years. In total, 23 reoperations and reinterventions were performed; 14 were allograft conduit replacements. Two patients required aortic valve plasty. None required valve replacement. The reintervention-free rate was 64.6% ± 10.8% at 2 years and 36.9% ± 11.3% at 5 years.
  
  
  CONCLUSIONS
  Pulmonary autografts demonstrated good durability with low mortality and morbidity. This study shows that the modified Ross-Konno procedure can be a practical choice in selective cases for complex LVOT stenosis in neonates and infants.
authors.affiliation: Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, California. maedak-tky@umin.ac.jp
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Maeda
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Rizal
authors.forename: Michael
authors.initials: M
authors.lastname: Lavrsen
authors.forename: Sunil P
authors.initials: SP
authors.lastname: Malhotra
authors.forename: Sami A
authors.initials: SA
authors.lastname: Akram
authors.forename: Ryan
authors.initials: R
authors.lastname: Davies
authors.forename: Sam
authors.initials: S
authors.lastname: Suleman
authors.forename: Olaf
authors.initials: O
authors.lastname: Reinhartz
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Murphy
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
authors.forename: V Mohan
authors.initials: VM
authors.lastname: Reddy
mesh_terms: D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D004695:Endocardial Fibroelastosis / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012086:Reoperation; D012189:Retrospective Studies; D014694:Ventricular Outflow Obstruction / Q000601:surgery