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Midterm results of the Ross procedure in children : An appraisal of the subannular implantation with interrupted sutures technique

Tran, Phan-Kiet LU ; Tsang, Victor T.; Cornejo, Patricia R.; Torii, Ryo; Dominguez, Troy; Tran-Lundmark, Karin LU ; Hsia, Tain Yen; Hughes, Marina; Muthialu, Nagarajan and Kostolny, Martin (2017) In European Journal of Cardio-thoracic Surgery 52(4). p.798-804
Abstract

OBJECTIVES: The support of the pulmonary autograft root by the fibromuscular left ventricular outflow tract is emphasized to address the concern related to the dilatation of the pulmonary autograft structures in the paediatric population. METHODS: This retrospective study analyses the outcomes of 75 children who were operated between 1998 and 2012 with the subannular interrupted sutures technique at a median age of 10.2 years (range, 5.3 months-18.0 years). Median follow-up time was 5.2 years (range, 3 days-13.2 years). RESULTS: There were no deaths, but there were 3 reinterventions on the autograft for regurgitation and 2 resections of left ventricular outflow tract obstruction. There was no significant autograft stenosis, and freedom... (More)

OBJECTIVES: The support of the pulmonary autograft root by the fibromuscular left ventricular outflow tract is emphasized to address the concern related to the dilatation of the pulmonary autograft structures in the paediatric population. METHODS: This retrospective study analyses the outcomes of 75 children who were operated between 1998 and 2012 with the subannular interrupted sutures technique at a median age of 10.2 years (range, 5.3 months-18.0 years). Median follow-up time was 5.2 years (range, 3 days-13.2 years). RESULTS: There were no deaths, but there were 3 reinterventions on the autograft for regurgitation and 2 resections of left ventricular outflow tract obstruction. There was no significant autograft stenosis, and freedom from moderate-to-severe regurgitation was 95% (95% confidence interval: 89-100) and 88% (95% confidence interval: 77-99) at 5 and 10 years, respectively. Median z-scores at the latest follow-up examination were, at the annulus, 0.31 [interquartile range (IQR) = -0.81 to 1.2]; at the sinus of Valsalva, 2.7 (IQR = 1.5-3.5); and at the sinotubular junction, 3.1 (IQR = 1.7-4.2). The correlation between z-scores and time after the operation was negative at the level of the annulus (r = -0.29, P = 0.034) but positive at the level of the sinus (r = +0.37, P = 0.005) and the sinotubular junction (r = +0.26, P = 0.068). The median rate of change in the z-score at the annulus was low, 0.065 z-score/year (IQR = -0.13 to 0.43). CONCLUSIONS: The subannular interrupted sutures implantation technique is associated with acceptable risks and, in the midterm, delivers limited annular dilatation, autograft regurgitation and delayed need for autograft reintervention.

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author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Aortic root, Congenital aortic stenosis, Left ventricular outflow tract obstruction, Ross, Subannular
in
European Journal of Cardio-thoracic Surgery
volume
52
issue
4
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:85030704079
ISSN
1010-7940
DOI
10.1093/ejcts/ezx113
language
English
LU publication?
no
id
bca6f600-c7c0-42f4-a586-305741cdc344
date added to LUP
2017-10-24 15:57:18
date last changed
2018-01-07 12:23:28
@article{bca6f600-c7c0-42f4-a586-305741cdc344,
  abstract     = {<p>OBJECTIVES: The support of the pulmonary autograft root by the fibromuscular left ventricular outflow tract is emphasized to address the concern related to the dilatation of the pulmonary autograft structures in the paediatric population. METHODS: This retrospective study analyses the outcomes of 75 children who were operated between 1998 and 2012 with the subannular interrupted sutures technique at a median age of 10.2 years (range, 5.3 months-18.0 years). Median follow-up time was 5.2 years (range, 3 days-13.2 years). RESULTS: There were no deaths, but there were 3 reinterventions on the autograft for regurgitation and 2 resections of left ventricular outflow tract obstruction. There was no significant autograft stenosis, and freedom from moderate-to-severe regurgitation was 95% (95% confidence interval: 89-100) and 88% (95% confidence interval: 77-99) at 5 and 10 years, respectively. Median z-scores at the latest follow-up examination were, at the annulus, 0.31 [interquartile range (IQR) = -0.81 to 1.2]; at the sinus of Valsalva, 2.7 (IQR = 1.5-3.5); and at the sinotubular junction, 3.1 (IQR = 1.7-4.2). The correlation between z-scores and time after the operation was negative at the level of the annulus (r = -0.29, P = 0.034) but positive at the level of the sinus (r = +0.37, P = 0.005) and the sinotubular junction (r = +0.26, P = 0.068). The median rate of change in the z-score at the annulus was low, 0.065 z-score/year (IQR = -0.13 to 0.43). CONCLUSIONS: The subannular interrupted sutures implantation technique is associated with acceptable risks and, in the midterm, delivers limited annular dilatation, autograft regurgitation and delayed need for autograft reintervention.</p>},
  author       = {Tran, Phan-Kiet and Tsang, Victor T. and Cornejo, Patricia R. and Torii, Ryo and Dominguez, Troy and Tran-Lundmark, Karin and Hsia, Tain Yen and Hughes, Marina and Muthialu, Nagarajan and Kostolny, Martin},
  issn         = {1010-7940},
  keyword      = {Aortic root,Congenital aortic stenosis,Left ventricular outflow tract obstruction,Ross,Subannular},
  language     = {eng},
  month        = {10},
  number       = {4},
  pages        = {798--804},
  publisher    = {Elsevier},
  series       = {European Journal of Cardio-thoracic Surgery},
  title        = {Midterm results of the Ross procedure in children : An appraisal of the subannular implantation with interrupted sutures technique},
  url          = {http://dx.doi.org/10.1093/ejcts/ezx113},
  volume       = {52},
  year         = {2017},
}