NDLI: The Ross procedure in children: preoperative haemodynamic manifestation has significant effect on late autograft re-operation.

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The Ross procedure in children: preoperative haemodynamic manifestation has significant effect on late autograft re-operation.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Alsoufi, Bahaaldin Manlhiot, Cedric Fadel, Bahaa Al-Ahmadi, Mamdouh Tamim, Mohammad McCrindle, Brian W. Canver, Charles C. Al-Halees, Zohair
Description	Country affiliation: Saudi Arabia Author Affiliation: Alsoufi B ( King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. balsoufi@hotmail.com)
Abstract	OBJECTIVES: The Ross procedure is the aortic valve-replacement procedure of choice in children. Nonetheless, late autograft re-operation for dilatation and/or valve regurgitation is of concern. We examined whether preoperative haemodynamic manifestation (e.g., stenosis, regurgitation and mixed aortic valve disease) affected late re-operation risk. METHODS: Medical records of 227 children who underwent the Ross procedure (1991-2004) were reviewed. Competing-risks methodology determined time-related prevalence and associated factors for two mutually exclusive end-states after the Ross procedure: (1) death prior to subsequent autograft re-operation and (2) autograft re-operation, with the remainder of patients being alive and free from subsequent autograft re-operation. RESULTS: There were 162 male patients (71%) in this study. Median age at surgery was 12.1 years (range: 1 week-18 years). The haemodynamic aortic valve dysfunction was primarily stenosis (n=40, 18%), primarily regurgitation (n=109, 48%) and mixed disease (n=78, 35%). Underlying pathology was rheumatic fever (n=104, 46%), congenital heart disease (n=113, 50%) and endocarditis (n=8, 3%). Competing-risks analysis showed that, at 10 years following the Ross procedure, â¼5% of patients had died, 16% had undergone autograft re-operation with aortic valve replacement and 79% were alive and free from autograft re-operation. Ten-year freedom from autograft re-operation for patients with preoperative stenosis, regurgitation and mixed disease was 97%, 69% and 93%, respectively, (p<0.001 for regurgitation vs others). Risk factors for increased risk of autograft re-operation were rheumatic fever (parameter estimates (PEs): 2.09 ± 0.75, p=0.006), and earlier year of surgery (PE: 0.20 ± 0.06, p=0.001). Ten-year freedom from homograft replacement was 81% and was not dependent on haemodynamic manifestation (PE: -0.16 ± 0.38, p=0.68). Significant factors for homograft replacement included fresh homografts (PE: 2.2 ± 0.63, p=0.01) and annular enlargement (PE: 1.11 ± 0.3, p=0.01). Ten-year freedom from cardiac re-operation other than auto-/homograft was 85%, higher in patients with preoperative aortic regurgitation (PE: 1.01 ± 0.42, p=0.02). Concomitant cardiac surgery was a significant factor for late cardiac re-operation other than auto-/homograft replacement (PE: 1.79 ± 0.39, p<0.001). CONCLUSIONS: The Ross procedure in children is associated with excellent survival. Late autograft re-operation may be required; however, it is more common in children with preoperative aortic regurgitation, especially those with rheumatic fever. Better patient selection in later era has mitigated the risk of autograft re-operation. Continued improved candidate selection, along with modifications in autograft implantation and root/sinotubular stabilisation techniques, may further decrease late autograft failure.
File Format	HTM / HTML
ISSN	10107940
e-ISSN	1873734X
Journal	European Journal of Cardio-Thoracic Surgery
Issue Number	5
Volume Number	38
Language	English
Publisher	Oxford University Press
Publisher Date	2010-11-01
Publisher Place	Germany
Access Restriction	Open
Subject Keyword	Discipline Cardiology__semicolon__surgery Aortic Valve Insufficiency Surgery Aortic Valve Stenosis Heart Valve Prosthesis Implantation Pulmonary Valve Transplantation Adolescent Bioprosthesis Child, Preschool Epidemiologic Methods Heart Defects, Congenital Heart Valve Prosthesis Infant Infant, Newborn Prognosis Prosthesis Failure Recurrence Reoperation Statistics & Numerical Data Rheumatic Heart Disease
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine Surgery Cardiology and Cardiovascular Medicine

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