Midterm results of the modified ross/konno procedure in neonates and infants

Katsuhide Maeda, Rachel E. Rizal, Michael Lavrsen, Sunil P. Malhotra, Sami A. Akram, Ryan R Davies, Sam Suleman, Olaf Reinhartz, Daniel J. Murphy, Frank L. Hanley, V. Mohan Reddy

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: The management of congenital aortic stenosis in neonates and infants continues to be a surgical challenge. We have performed the modified Ross-Konno procedure for patients who have severe aortic insufficiency or significant residual stenosis after balloon aortic dilation. The midterm results of this procedure were evaluated in this subset of patients. Methods: Between 1994 and 2010, a total of 24 patients younger than 1 year of age underwent the modified Ross-Konno procedure. The diagnoses were aortic stenosis with or without subaortic stenosis (n = 16), Shone's complex (n = 7), and interrupted aortic arch with subaortic stenosis (n = 1). The aortic root was replaced with a pulmonary autograft, and the left ventricular outflow tract (LVOT) was enlarged with a right ventricular infundibular free wall muscular extension harvested with the autograft. Results: Age at operation ranged from 1 to 236 days (median 28 days). The median follow-up period was 81 months (range 1-173 months). There was 1 early death and no late mortality. Overall the 1-, 2-, and 5-year survival rate was 95% ± 4.5%. Freedom from aortic stenosis was 94.7% ± 5.1% at 1, 2, and 5 years. Less than mild aortic insufficiency was 93.3% ± 6.4% at 2 years, and 74.7% ± 12.9% at 5 years. In total, 23 reoperations and reinterventions were performed; 14 were allograft conduit replacements. Two patients required aortic valve plasty. None required valve replacement. The reintervention-free rate was 64.6% ± 10.8% at 2 years and 36.9% ± 11.3% at 5 years. Conclusions: Pulmonary autografts demonstrated good durability with low mortality and morbidity. This study shows that the modified Ross-Konno procedure can be a practical choice in selective cases for complex LVOT stenosis in neonates and infants.

Original languageEnglish (US)
Pages (from-to)156-163
Number of pages8
JournalAnnals of Thoracic Surgery
Volume94
Issue number1
DOIs
StatePublished - Jul 1 2012

Fingerprint

Newborn Infant
Aortic Valve Stenosis
Autografts
Pathologic Constriction
Lung
Mortality
Thoracic Aorta
Aortic Valve
Reoperation
Allografts
Dilatation
Survival Rate
Morbidity

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Maeda, K., Rizal, R. E., Lavrsen, M., Malhotra, S. P., Akram, S. A., Davies, R. R., ... Reddy, V. M. (2012). Midterm results of the modified ross/konno procedure in neonates and infants. Annals of Thoracic Surgery, 94(1), 156-163. https://doi.org/10.1016/j.athoracsur.2012.03.007

Midterm results of the modified ross/konno procedure in neonates and infants. / Maeda, Katsuhide; Rizal, Rachel E.; Lavrsen, Michael; Malhotra, Sunil P.; Akram, Sami A.; Davies, Ryan R; Suleman, Sam; Reinhartz, Olaf; Murphy, Daniel J.; Hanley, Frank L.; Reddy, V. Mohan.

In: Annals of Thoracic Surgery, Vol. 94, No. 1, 01.07.2012, p. 156-163.

Research output: Contribution to journalArticle

Maeda, K, Rizal, RE, Lavrsen, M, Malhotra, SP, Akram, SA, Davies, RR, Suleman, S, Reinhartz, O, Murphy, DJ, Hanley, FL & Reddy, VM 2012, 'Midterm results of the modified ross/konno procedure in neonates and infants', Annals of Thoracic Surgery, vol. 94, no. 1, pp. 156-163. https://doi.org/10.1016/j.athoracsur.2012.03.007
Maeda, Katsuhide ; Rizal, Rachel E. ; Lavrsen, Michael ; Malhotra, Sunil P. ; Akram, Sami A. ; Davies, Ryan R ; Suleman, Sam ; Reinhartz, Olaf ; Murphy, Daniel J. ; Hanley, Frank L. ; Reddy, V. Mohan. / Midterm results of the modified ross/konno procedure in neonates and infants. In: Annals of Thoracic Surgery. 2012 ; Vol. 94, No. 1. pp. 156-163.
@article{7b95a61c7e8849059fc6fab1b3f5e437,
title = "Midterm results of the modified ross/konno procedure in neonates and infants",
abstract = "Background: The management of congenital aortic stenosis in neonates and infants continues to be a surgical challenge. We have performed the modified Ross-Konno procedure for patients who have severe aortic insufficiency or significant residual stenosis after balloon aortic dilation. The midterm results of this procedure were evaluated in this subset of patients. Methods: Between 1994 and 2010, a total of 24 patients younger than 1 year of age underwent the modified Ross-Konno procedure. The diagnoses were aortic stenosis with or without subaortic stenosis (n = 16), Shone's complex (n = 7), and interrupted aortic arch with subaortic stenosis (n = 1). The aortic root was replaced with a pulmonary autograft, and the left ventricular outflow tract (LVOT) was enlarged with a right ventricular infundibular free wall muscular extension harvested with the autograft. Results: Age at operation ranged from 1 to 236 days (median 28 days). The median follow-up period was 81 months (range 1-173 months). There was 1 early death and no late mortality. Overall the 1-, 2-, and 5-year survival rate was 95{\%} ± 4.5{\%}. Freedom from aortic stenosis was 94.7{\%} ± 5.1{\%} at 1, 2, and 5 years. Less than mild aortic insufficiency was 93.3{\%} ± 6.4{\%} at 2 years, and 74.7{\%} ± 12.9{\%} at 5 years. In total, 23 reoperations and reinterventions were performed; 14 were allograft conduit replacements. Two patients required aortic valve plasty. None required valve replacement. The reintervention-free rate was 64.6{\%} ± 10.8{\%} at 2 years and 36.9{\%} ± 11.3{\%} at 5 years. Conclusions: Pulmonary autografts demonstrated good durability with low mortality and morbidity. This study shows that the modified Ross-Konno procedure can be a practical choice in selective cases for complex LVOT stenosis in neonates and infants.",
author = "Katsuhide Maeda and Rizal, {Rachel E.} and Michael Lavrsen and Malhotra, {Sunil P.} and Akram, {Sami A.} and Davies, {Ryan R} and Sam Suleman and Olaf Reinhartz and Murphy, {Daniel J.} and Hanley, {Frank L.} and Reddy, {V. Mohan}",
year = "2012",
month = "7",
day = "1",
doi = "10.1016/j.athoracsur.2012.03.007",
language = "English (US)",
volume = "94",
pages = "156--163",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - Midterm results of the modified ross/konno procedure in neonates and infants

AU - Maeda, Katsuhide

AU - Rizal, Rachel E.

AU - Lavrsen, Michael

AU - Malhotra, Sunil P.

AU - Akram, Sami A.

AU - Davies, Ryan R

AU - Suleman, Sam

AU - Reinhartz, Olaf

AU - Murphy, Daniel J.

AU - Hanley, Frank L.

AU - Reddy, V. Mohan

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Background: The management of congenital aortic stenosis in neonates and infants continues to be a surgical challenge. We have performed the modified Ross-Konno procedure for patients who have severe aortic insufficiency or significant residual stenosis after balloon aortic dilation. The midterm results of this procedure were evaluated in this subset of patients. Methods: Between 1994 and 2010, a total of 24 patients younger than 1 year of age underwent the modified Ross-Konno procedure. The diagnoses were aortic stenosis with or without subaortic stenosis (n = 16), Shone's complex (n = 7), and interrupted aortic arch with subaortic stenosis (n = 1). The aortic root was replaced with a pulmonary autograft, and the left ventricular outflow tract (LVOT) was enlarged with a right ventricular infundibular free wall muscular extension harvested with the autograft. Results: Age at operation ranged from 1 to 236 days (median 28 days). The median follow-up period was 81 months (range 1-173 months). There was 1 early death and no late mortality. Overall the 1-, 2-, and 5-year survival rate was 95% ± 4.5%. Freedom from aortic stenosis was 94.7% ± 5.1% at 1, 2, and 5 years. Less than mild aortic insufficiency was 93.3% ± 6.4% at 2 years, and 74.7% ± 12.9% at 5 years. In total, 23 reoperations and reinterventions were performed; 14 were allograft conduit replacements. Two patients required aortic valve plasty. None required valve replacement. The reintervention-free rate was 64.6% ± 10.8% at 2 years and 36.9% ± 11.3% at 5 years. Conclusions: Pulmonary autografts demonstrated good durability with low mortality and morbidity. This study shows that the modified Ross-Konno procedure can be a practical choice in selective cases for complex LVOT stenosis in neonates and infants.

AB - Background: The management of congenital aortic stenosis in neonates and infants continues to be a surgical challenge. We have performed the modified Ross-Konno procedure for patients who have severe aortic insufficiency or significant residual stenosis after balloon aortic dilation. The midterm results of this procedure were evaluated in this subset of patients. Methods: Between 1994 and 2010, a total of 24 patients younger than 1 year of age underwent the modified Ross-Konno procedure. The diagnoses were aortic stenosis with or without subaortic stenosis (n = 16), Shone's complex (n = 7), and interrupted aortic arch with subaortic stenosis (n = 1). The aortic root was replaced with a pulmonary autograft, and the left ventricular outflow tract (LVOT) was enlarged with a right ventricular infundibular free wall muscular extension harvested with the autograft. Results: Age at operation ranged from 1 to 236 days (median 28 days). The median follow-up period was 81 months (range 1-173 months). There was 1 early death and no late mortality. Overall the 1-, 2-, and 5-year survival rate was 95% ± 4.5%. Freedom from aortic stenosis was 94.7% ± 5.1% at 1, 2, and 5 years. Less than mild aortic insufficiency was 93.3% ± 6.4% at 2 years, and 74.7% ± 12.9% at 5 years. In total, 23 reoperations and reinterventions were performed; 14 were allograft conduit replacements. Two patients required aortic valve plasty. None required valve replacement. The reintervention-free rate was 64.6% ± 10.8% at 2 years and 36.9% ± 11.3% at 5 years. Conclusions: Pulmonary autografts demonstrated good durability with low mortality and morbidity. This study shows that the modified Ross-Konno procedure can be a practical choice in selective cases for complex LVOT stenosis in neonates and infants.

UR - http://www.scopus.com/inward/record.url?scp=84862843908&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862843908&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2012.03.007

DO - 10.1016/j.athoracsur.2012.03.007

M3 - Article

C2 - 22626750

AN - SCOPUS:84862843908

VL - 94

SP - 156

EP - 163

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -