Author + information
- Received April 20, 2020
- Revision received July 22, 2020
- Accepted July 31, 2020
- Published online September 21, 2020.
- Edward Buratto, MBBS, PhDa,b,c,
- Fraser R.O. Wallace, MDa,
- Tyson A. Fricke, MBBSa,b,c,
- Johann Brink, MDa,
- Yves d’Udekem, MD, PhDa,b,c,d,
- Christian P. Brizard, MDa,b,c,d and
- Igor E. Konstantinov, MD, PhDa,b,c,d,∗ ()
- aDepartment of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia
- bDepartment of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- cHeart Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- dThe Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Murdoch Children's Institute, Melbourne, Victoria, Australia
- ↵∗Address for correspondence:
Dr. Igor E. Konstantinov, Royal Children’s Hospital, Flemington Road, Parkville, Victoria 3029, Australia.
Background The Ross procedure in children is performed either as a primary operation, or a secondary operation after initial aortic valve surgery.
Objectives The study aimed to determine whether the outcomes of primary and secondary Ross procedure are similar.
Methods All patients who underwent Ross procedure between 1995 and 2018 were included in the study. Outcomes were compared between those who had primary Ross procedure and those who had secondary Ross procedure, after aortic valve surgery. Propensity score matching for baseline characteristics and risk factors for death and reoperation was performed.
Results Of 140 Ross procedures, 51.4% (n = 72 of 140) were primary operations, while 48.6% (n = 68 of 140) were secondary operations. Patients undergoing primary Ross procedure tended to be older (median age 8.6 years vs. 7.0 years; p = 0.10) and have a higher weight (28.9 kg vs. 19.4 kg; p = 0.07). There were no significant differences in survival or freedom from reoperation in the unmatched cohort. Propensity score matching resulted in 50 well-matched pairs. In the matched cohort, survival at 10 years was 90.0% (95% confidence interval [CI]: 77.5% to 95.7%) in the primary Ross group, compared with 96.8% (95% CI: 79.2% to 99.5%) in the secondary Ross group (p = 0.04). Freedom from autograft reoperation at 10 years was 82% (95% CI: 64.1% to 91.5%) in the primary Ross group, compared with 97.0% (95% CI: 80.4% to 99.6%) in the secondary Ross group (p = 0.03).
Conclusions Secondary Ross procedure performed after initial aortic valve surgery achieves superior long-term survival and freedom from autograft reoperation compared with primary Ross procedure. A strategy of initial aortic valve repair followed by delayed Ross procedure may provide better long-term survival and freedom from autograft reoperation.
Dr. d’Udekem is a National Health and Medical Research Council Clinician Practitioner Fellow (no. 1082186); and has served as a consultant for Actelion and Merck Sharp & Dohme. Dr. Brizard has served on the advisory board of Admedus. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received April 20, 2020.
- Revision received July 22, 2020.
- Accepted July 31, 2020.
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