The fate of the neoaortic valve and root following the modified Ross-Konno

Abstract

In children with aortic valve disease associated with annular hypoplasia or complex multi-level left ventricular outflow tract obstruction (LVOTO), the Ross procedure, combined with a modified Konno-type aortoventriculoplasty is advocated. We aim to examine the fate of the neoaortic apparatus and assess neoaortic valve function following the modified Ross-Konno procedure. Forty-three patients, median age 6 years, underwent modified Ross- Konno with myectomy but without ventricular septal patch utilization. Serial postoperative echocardiograms ( n = 187) were analyzed and regression models adjusted for repeated measures were used to model longitudinal growth of neoaortic annulus and root. There were 2 operative deaths (5%) and 1 late mortality. At 8 years, survival was 93% and freedom from autograft, homograft and all-cause reoperation was 100%, 81%, and 72%, respectively. Median post-procedure diameter and Z-score were 14 mm (7–21 mm), and 1.25 (−3 to +6.1) for neoaortic annulus and 21 mm (9–30 mm) and 1.55 (−1.3 to +4.1) for neoaortic root. Serial echocardiograms showed progressive increase in annular (+0.56 mm/year, p < 0.001) and root (+0.89 mm/year, p < 0.001) diameters but little change in annular (−0.07/year, p = 0.08) and root (−0.002/year, p = 0.96) Z-scores. Nine patients developed autograft regurgitation, however the degree and progression of regurgitation were not significant ( p = 0.22). In children undergoing the modified Ross-Konno procedure, the neoaortic annulus and root increase in size proportionately to somatic growth. Few patients developed autograft regurgitation, usually mild and stable, and none required autograft reoperation. Our findings support the use of modified Ross-Konno as the procedure of choice in children with aortic valve disease and complex LVOTO.