title: Ross-Konno procedure in infants: mid-term results.
abstract: OBJECTIVE
  The aim of study was to analyse the mid-term results of the Ross-Konno procedure in infants.
  
  
  METHODS
  Between 2000 and 2011, 16 infants, including five newborns, with complex left ventricular outflow tract (LVOT) obstruction underwent the Ross-Konno procedure. Twelve patients (75%) required multiple concomitant procedures such as: mitral valve (MV) surgery (four patients), resection of endocardial fibroelastosis (EFE) and myectomy (six patients), closure of ventricular septal defect (four patients) and aortic arch reconstruction (three patients). The median age at operation was 4.2 months (from 6 to 333 days).
  
  
  RESULTS
  There was one late death with a median follow-up of 6.2 years. Actuarial survival is 93.3% at 5 years follow-up (95% confidence interval: 61.2-99.0). Postoperatively, two patients required extracorporeal membrane oxygenation support and one MV replacement. The median length of stay in hospital was 30 days (from 11 to 77 days). At 5 years of follow-up, seven patients had no aortic regurgitation (AR) and nine patients (56%) had trivial AR with no gradient in LVOT. Freedom from mitral regurgitation (MR) ≥ moderate or MV replacement was 70%. MR was associated with either structural abnormalities of MV or with development of EFE. Freedom from redo was 81 and 53% at 1 and 5 years of follow-up. Sixty percent of patients are without medication. All patients are in sinus rhythm.
  
  
  CONCLUSIONS
  With the technical aspects of this procedure well accomplished, the risk of surgery is minimal and functional outcome is encouraging. However, early postoperative morbidity is significant. At the mid-term follow-up, there was no residual or recurrent outflow tract obstruction and excellent function of the neoaortic valve. A high incidence of MR associated with the development of EFE and structural abnormalities of the MV is worrisome; however, concomitant MV surgery is not associated with increased mortality. In the case of the development of EFE, an early indication for operation might protect MV function. The reoperation rate is high due to early conduit failure.
authors.affiliation: German Pediatric Heart Centre,  Asklepios Clinic Sankt Augustin, Sankt Augustin,  Germany.
authors.forename: Pauline
authors.initials: P
authors.lastname: Aszyk
authors.forename: Christian
authors.initials: C
authors.lastname: Thiel
authors.forename: Nicodème
authors.initials: N
authors.lastname: Sinzobahamvya
authors.forename: Stefanie
authors.initials: S
authors.lastname: Luetter
authors.forename: Joachim
authors.initials: J
authors.lastname: Photiadis
authors.forename: Christoph
authors.initials: C
authors.lastname: Haun
authors.forename: Boulos
authors.initials: B
authors.lastname: Asfour
authors.forename: Viktor
authors.initials: V
authors.lastname: Hraska
mesh_terms: D000015:Abnormalities, Multiple / Q000401:mortality / Q000601:surgery; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011651:Pulmonary Artery / Q000601:surgery*; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D054088:Ventricular Septum / Q000601:surgery*