Re-interventions on the autograft and the homograft after the Ross operation in children

• Published in: European journal of cardio-thoracic surgery 2010-05, Vol.37 (5), p.1008-1014
• Main Authors: Hörer, Jürgen, Stierle, Ulrich, Bogers, Ad J.J.C., Rein, Joachim G., Hetzer, Roland, Sievers, Hans H., Lange, Rüdiger
• Format: Article
• Language: English
• Subjects: Adolescent; Aorta - surgery; Aortic Valve - surgery; Aortic valve disease; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Child; Child, Preschool; Congenital – acyanotic; Endocardial and cardiac valvular diseases; Epidemiologic Methods; Female; Heart; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Humans; Infant; Male; Medical sciences; Pneumology; Postoperative Period; Prognosis; Pulmonary Valve - transplantation; Reoperation; Ross operation; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2009.10.032

Background: For children who require aortic valve replacement, the pulmonary autograft may be the ideal substitute. However, re-operations for conduit exchange in the pulmonary position are inevitable. In addition, re-operations on the autograft may be necessary due to dilatation and neo-aortic insufficiency. We sought to assess predictors for re-intervention in an international Ross-operated paediatric population. Methods: Data of 152 children below 16 years of age at the time of the Ross operation were analysed using Cox proportional hazard modelling. Mean follow-up time was 6.1 ± 4.2 years. Results: The median age at the time of the Ross operation was 10.1 years (range 54 days to 15 years). Early mortality was 2.6%. Survival at 5 and 10 years was 93.9 ± 2.0% and 90.4 ± 3.1%, respectively. Seven patients required autograft re-intervention (explantation n = 6 and reconstruction n = 1). Freedom from autograft re-intervention at 5 and 10 years was 99.3 ± 0.7% and 95.5 ± 2.7%, respectively. Prior endocarditis (p = 0.061), prior aortic regurgitation (p = 0.061) and longer follow-up time (p = 0.036) emerged as risk factors for autograft re-intervention. Seventeen patients required 36 conduit re-interventions (replacement n = 16, percutaneous valvuloplasty n = 10). Freedom from conduit re-intervention at 5 and 10 years was 89.3 ± 2.9% and 79.6 ± 6.1%, respectively. Implantation of an aortic homograft (p = 0.013), and smaller conduit size (p = 0.074) emerged as risk factors for conduit re-intervention. Conclusions: There is a consistent need for conduit re-intervention following the Ross operation in children. Re-interventions on the autograft are rare within the first decade after surgery. However, the number of autograft re-interventions may increase after the first decade, since longer follow-up time is a risk factor for autograft failure.