Abstract 19508: Mid-term Results of the Ross Procedure in Children: A Reappraisal of the Subannular Implantation Technique

Abstract

Dilatation of the pulmonary autograft is an ongoing concern in the paediatric population. Unlike those of the aortic valve leaflets, those of the pulmonary valve are directly attached to the right ventricular muscular outflow tract, and therefore at the time of the Ross procedure the pulmonary root needs to be placed within the left ventricular outflow (LVOT) tract for support. Between 1998 and 2012, 74 children were operated with the subannular technique with interrupted sutures, at the median age of 10.2 years (range 5 months to 18 years). Mean follow up time was 5.2 years (range 3 days to 13.2 years). There were no deaths, but 3 reinterventions on the autograft for regurgitation and 2 resections of LVOT obstruction. Mean freedom from autograft and LVOT reintervention time was 12.1 years (95% CI 11.0 - 13.2). There were no significant autograft stenosis, and freedom from moderate to severe autograft regurgitation was 95% and 87.5% at 5 and 10 years, respectively. Z-scores at latest follow-up were at the annulus 0.23 (range -2.9 to +3.2), sinus of Valsalva 2.6 (range -3.1 to +5.4), and the sinotubular junction 2.9 (range -1.2 to +6.0). As expected, the correlation between time after surgery and the increase in Z-score of the root structures were positive at the level of the sinus of Valsalva (r=+0.39, p=0.003) and at the sinotubular junction (r=+0.27, p=0.049), but was negative at the annulus (r=-0.26, p=0.054). Average rate of change in Z-score was significantly lower at the annulus compared to the sinus of Valsalva (0.19 vs 0.46 Z-score/year, p < 0.001). Our data confirms the importance of subannular support of the pulmonary autograft in the LVOT with limited annular dilatation and autograft regurgitation, and delayed need for autograft reintervention.