[II-IPD-04] The Ross procedure in pediatric patients
Background. The lack of anticoagulation, proven growth potential, and good durability make the Ross procedure an excellent option for aortic valve replacement (AVR) in children. At the University of Michigan (U-M), it is the favored approach for children requiring an AVR.
Methods. Two retrospective analyses were done at U-M to evaluate our Ross outcomes. The first looked specifically at all patients <1 year of age, who underwent a Ross/Konno from 1993-2000. The second evaluated all patients <18 years of age undergoing a Ross from 1991-2013.
Results. There were 10 subjects in the Ross/Konno <1 year of age group with a median age of 16 days (range; 2-349 days). There were no deaths at a median follow-up of 48 months (range; 1 to 74 months). All patients had none to mild aortic stenosis. Eight patients had a 0 to 1+ aortic insufficiency (AI), 1 patient had a 2+ AI, and 1 patient had a 3+ AI. No patient required additional procedures for aortic valve disease. Two patients required three pulmonary allograft replacements.In the overall Ross experience, there were 240 consecutive patients, 18% infants, 48% children, and 33% adolescents. Overall survival to hospital discharge was 96%; infants had the highest mortality (18%). At a median follow-up of 11 years, the overall 15-year survival was 87% (lowest in infants, 72%; p [ 0.003). Overall 15-year freedom from any left ventricular outflow tract reintervention was 59%; 85% still had their autograft valve. Autograft reintervention was very rare in infants. 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. While outcomes vary by age at the time of the Ross, overall results are very good, which when coupled with the advantages of the Ross, make it an excellent choice for AVR in children.
Methods. Two retrospective analyses were done at U-M to evaluate our Ross outcomes. The first looked specifically at all patients <1 year of age, who underwent a Ross/Konno from 1993-2000. The second evaluated all patients <18 years of age undergoing a Ross from 1991-2013.
Results. There were 10 subjects in the Ross/Konno <1 year of age group with a median age of 16 days (range; 2-349 days). There were no deaths at a median follow-up of 48 months (range; 1 to 74 months). All patients had none to mild aortic stenosis. Eight patients had a 0 to 1+ aortic insufficiency (AI), 1 patient had a 2+ AI, and 1 patient had a 3+ AI. No patient required additional procedures for aortic valve disease. Two patients required three pulmonary allograft replacements.In the overall Ross experience, there were 240 consecutive patients, 18% infants, 48% children, and 33% adolescents. Overall survival to hospital discharge was 96%; infants had the highest mortality (18%). At a median follow-up of 11 years, the overall 15-year survival was 87% (lowest in infants, 72%; p [ 0.003). Overall 15-year freedom from any left ventricular outflow tract reintervention was 59%; 85% still had their autograft valve. Autograft reintervention was very rare in infants. 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. While outcomes vary by age at the time of the Ross, overall results are very good, which when coupled with the advantages of the Ross, make it an excellent choice for AVR in children.