SHA24/055006

THE FATE OF THE NEOAORTIC VALVE AND ROOT FOLLOWING THE MODIFIED ROSS-KONNO PROCEDURE Ismail Al Abri

Zohair Al-Halees

Bahaa Fadel

Bahaaldin Alsoufi

King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

Background • Ross procedure: AVR of choice in children • Aorto-ventriculoplasty (Ross-Konno): – Severe annular hypoplasia – Complex LVOT obstruction

VSD patch Incision into “Konno” septum

Pastuszko & Spray: Oper Tech Thorac Cardiovasc Surg 2002

Background • Concerns: – Annular & root dilatation – Neoaortic regurgitation – Autograft reoperation

• Risk Factors: – Pre-operative regurgitation Applicable toannulus Ross-Konno population – Dilated aortic – Mismatch AV larger than PV – Disruption of supporting annulus Not applicable to Ross-Konno – VSD patch population

Aims and Methods • Describe clinical outcomes: – Survival – Cardiac reoperation

• Fate of neoaortic valve and root

Patients (n=43) Age: median 6 Y (range 15 D â&#x20AC;&#x201C; 27 Y) <3Y 3 â&#x20AC;&#x201C; 10 Y > 10 Y

n=16 (37%) n=16 (37%) n=11 (26%)

Procedure

Annular incision Septal myectomy

Concomitant Surgery n=10 (23%) Mitral n=5 Arch n=4 No VSD patch Other n=2

CLINICAL OUTCOMES

Survival 93%

2 operative deaths 1 late mortality

Reoperation 93%

2 operative deaths 1 late mortality43% 12 No reoperations autograft 9 homograft reoperation change

ECHOCARDIOGRAPHIC FOLLOW-UP

Echocardiographic Data Serial echocardiograms collected N=187 Median 5 / patient Range 2-11 Regression models of longitudinal growth of annulus, root and progression of AI

(mm)

Annular Growth

No concomitant surgery

Concomitant surgery

Older Progressive Patients No increase patients with increase inconcomitant start annulus with in Z annulus lower score surgery Z with diameter: score have time: but a trend have a for trend +0.56 more -0.07 for mm Z more score /Y /Y (p=0.08) increase (p<0.001) increase with with time time

(mm)

Root Growth

Progressive No Older increase patients increase in root haveZain score trend rootwith diameter: for more time: increase + 0.88 - 0.002 in mm root //Y ZY(p=0.96) score (p<0.001) with time

Neoaortic Regurgitation AR ratio by color Doppler: Regurgitation jet width / aortic annulus < 0.25 0.25-0.45 0.45-0.65 > 0.65

mild moderate moderate â&#x20AC;&#x201C; severe severe

Neoaortic Regurgitation AR (n=9): AR grade:

Early (n=7) Late (n=2) Mild (n=7) Mild-mod (n=2)

Older patients Stable have AR a ratio: trend for more increase + 0.001 in AR /Y ratio (p=0.22) with time

Conclusions • Evidence of autograft growth • Stable annulus & root Z scores: growth proportional to somatic enlargement • Rare autograft regurgitation, usually mild and non-progressive • No autograft reoperation within our followup interval • Results support modified Ross-Konno as the procedure of choice in children with complex LVOTO