Long-Term Survival and Reintervention After the Ross Procedure Across the Pediatric Age Spectrum.
BACKGROUND
There are limited data regarding long-term outcomes after the Ross procedure in children. We evaluated mortality and reintervention in a large pediatric cohort.


METHODS
A retrospective analysis of all patients aged younger than 18 years who underwent the Ross procedure at our institution (1991 to 2013) was conducted. Kaplan-Meier curves and Cox proportion hazard models were used to evaluate long-term outcomes and associated risk factors.


RESULTS
Included were 240 consecutive patients undergoing a Ross/Ross-Konno procedure: 18% infants, 48% children, and 33% adolescents. Infants were more likely to have complex left heart disease (p = 0.005). Overall survival to hospital discharge was 96%; infants had the highest mortality (18%). Long-term survival status was known for 99.6% (median follow-up, 10.7 years). Overall 15-year survival was 87% (lowest in infants, 72%; p = 0.003). Reintervention status was known in 87%. Overall 15-year freedom from any left ventricular outflow tract reintervention was 59%; 85% still had their autograft valve at the latest follow-up. Left ventricular outflow tract reintervention was uncommon in infants (n = 2). Overall 15-year freedom from right ventricular outflow tract reintervention was 53%, and was lower in infants (19%) than in children (51%) and adolescents (76%; p < 0.0001).


CONCLUSIONS
Outcomes after the Ross procedure in children vary by age. Infants more commonly have complex left heart disease and experience higher mortality but have excellent long-term autograft durability. Children and adolescents have higher rates of left ventricular outflow tract reintervention, whereas infants are at highest risk of right ventricular outflow tract reintervention.
Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: jennifer_nelson@med.unc.edu.
Jennifer S
JS
Nelson
Division of Pediatric Cardiology, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan.
Sara K
SK
Pasquali
Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Clayton N
CN
Pratt
Division of Pediatric Cardiology, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan.
Sunkyung
S
Yu
Division of Pediatric Cardiology, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan.
Janet E
JE
Donohue
Division of Pediatric Cardiology, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan.
Emefah
E
Loccoh
Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Richard G
RG
Ohye
Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Edward L
EL
Bove
Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Jennifer C
JC
Hirsch-Romano
D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008824:Michigan / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors