Abstract
Objective: Children undergoing Ross operation were expected to have longer autograft, but shorter homograft durability compared with adults. In order to define the outcome in the second decade after Ross operation in children, a nationwide review of 23 years of experience was undertaken. Methods: 305 children underwent Ross operation in 11 paediatric units between 1990 and 2012. Age at surgery was 9.4±5.7 years, indication aortic stenosis in 103 patients, regurgitation in 109 and mixed lesion in 93. 116 (38%) patients had prior procedures. Root replacement was performed in 201 patients, inclusion cylinder in 14, subcoronary grafting in 17 and Ross-Konno in 73. Results: There were 10 (3.3%) hospital and 12 late deaths (median follow-up 8.7 years). Survival was 93±2% and 89±3% and freedom from any reoperation was 76±3% and 67±6% at 10 and 15 years. 34 children had autograft 37 reoperations (25 replacement, 12 repair): three required transplantation after reoperation. Freedom from autograft reoperation was 86±3% and 75±6% at 10 and 15 years. 32 children had right heart redo procedures, and only 25 (78%) conduit replacements (15-year freedom from replacement, 89±4%). Prior operation (p=0.031), subcoronary implant (p=0.025) and concomitant surgical procedure (p=0.004) were risk factors for left heart reoperation, while infant age ( p=0.015) was for right heart. The majority (87%) of late survivors were in NYHA class I, 68% free from medication and six women had pregnancies. Conclusions: Despite low hospital risk and satisfactory late survival, paediatric Ross operation bears substantial valve-related morbidity in the first two decades. Contrary to expectation, autograft reoperation is more common than homograft.
| Original language | English |
|---|---|
| Pages (from-to) | 1954-1959 |
| Number of pages | 6 |
| Journal | Heart |
| Volume | 100 |
| Issue number | 24 |
| DOIs | |
| Publication status | Published - Dec 1 2014 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Medicine(all)
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Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry. / Luciani, Giovanni Battista; Lucchese, Gianluca; Carotti, Adriano; Brancaccio, Gianluca; Abbruzzese, Piero; Caianiello, Giuseppe; Galletti, Lorenzo; Gargiulo, Gaetano Domenico; Marianeschi, Stefano Maria; Mazzucco, Alessandro; Faggian, Giuseppe; Murzi, Bruno; Napoleone, Carlo Pace; Pozzi, Marco; Zannini, Lucio; Frigiola, Alessandro.
In: Heart, Vol. 100, No. 24, 01.12.2014, p. 1954-1959.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry
AU - Luciani, Giovanni Battista
AU - Lucchese, Gianluca
AU - Carotti, Adriano
AU - Brancaccio, Gianluca
AU - Abbruzzese, Piero
AU - Caianiello, Giuseppe
AU - Galletti, Lorenzo
AU - Gargiulo, Gaetano Domenico
AU - Marianeschi, Stefano Maria
AU - Mazzucco, Alessandro
AU - Faggian, Giuseppe
AU - Murzi, Bruno
AU - Napoleone, Carlo Pace
AU - Pozzi, Marco
AU - Zannini, Lucio
AU - Frigiola, Alessandro
PY - 2014/12/1
Y1 - 2014/12/1
N2 - Objective: Children undergoing Ross operation were expected to have longer autograft, but shorter homograft durability compared with adults. In order to define the outcome in the second decade after Ross operation in children, a nationwide review of 23 years of experience was undertaken. Methods: 305 children underwent Ross operation in 11 paediatric units between 1990 and 2012. Age at surgery was 9.4±5.7 years, indication aortic stenosis in 103 patients, regurgitation in 109 and mixed lesion in 93. 116 (38%) patients had prior procedures. Root replacement was performed in 201 patients, inclusion cylinder in 14, subcoronary grafting in 17 and Ross-Konno in 73. Results: There were 10 (3.3%) hospital and 12 late deaths (median follow-up 8.7 years). Survival was 93±2% and 89±3% and freedom from any reoperation was 76±3% and 67±6% at 10 and 15 years. 34 children had autograft 37 reoperations (25 replacement, 12 repair): three required transplantation after reoperation. Freedom from autograft reoperation was 86±3% and 75±6% at 10 and 15 years. 32 children had right heart redo procedures, and only 25 (78%) conduit replacements (15-year freedom from replacement, 89±4%). Prior operation (p=0.031), subcoronary implant (p=0.025) and concomitant surgical procedure (p=0.004) were risk factors for left heart reoperation, while infant age ( p=0.015) was for right heart. The majority (87%) of late survivors were in NYHA class I, 68% free from medication and six women had pregnancies. Conclusions: Despite low hospital risk and satisfactory late survival, paediatric Ross operation bears substantial valve-related morbidity in the first two decades. Contrary to expectation, autograft reoperation is more common than homograft.
AB - Objective: Children undergoing Ross operation were expected to have longer autograft, but shorter homograft durability compared with adults. In order to define the outcome in the second decade after Ross operation in children, a nationwide review of 23 years of experience was undertaken. Methods: 305 children underwent Ross operation in 11 paediatric units between 1990 and 2012. Age at surgery was 9.4±5.7 years, indication aortic stenosis in 103 patients, regurgitation in 109 and mixed lesion in 93. 116 (38%) patients had prior procedures. Root replacement was performed in 201 patients, inclusion cylinder in 14, subcoronary grafting in 17 and Ross-Konno in 73. Results: There were 10 (3.3%) hospital and 12 late deaths (median follow-up 8.7 years). Survival was 93±2% and 89±3% and freedom from any reoperation was 76±3% and 67±6% at 10 and 15 years. 34 children had autograft 37 reoperations (25 replacement, 12 repair): three required transplantation after reoperation. Freedom from autograft reoperation was 86±3% and 75±6% at 10 and 15 years. 32 children had right heart redo procedures, and only 25 (78%) conduit replacements (15-year freedom from replacement, 89±4%). Prior operation (p=0.031), subcoronary implant (p=0.025) and concomitant surgical procedure (p=0.004) were risk factors for left heart reoperation, while infant age ( p=0.015) was for right heart. The majority (87%) of late survivors were in NYHA class I, 68% free from medication and six women had pregnancies. Conclusions: Despite low hospital risk and satisfactory late survival, paediatric Ross operation bears substantial valve-related morbidity in the first two decades. Contrary to expectation, autograft reoperation is more common than homograft.
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U2 - 10.1136/heartjnl-2014-305873
DO - 10.1136/heartjnl-2014-305873
M3 - Article
C2 - 25056868
AN - SCOPUS:84922482180
VL - 100
SP - 1954
EP - 1959
JO - Heart
JF - Heart
SN - 1355-6037
IS - 24
ER -