The Landscape of Congenital Heart Disease Treated with the Ross Procedure
Presented During:
Sunday, April 28, 2024: 9:58AM - 10:05AM
Metro Toronto Convention Center
Posted Room Name:
Room 716
Abstract No:
134
Submission Type:
Abstract Submission
Authors:
Markian Bojko (1), Luke Wiggins (1), John Cleveland (1), Ramsey Elsayed (2), David Cleveland (1), Vaughn Starnes (1)
Institutions:
(1) Heart Institute, Children's Hospital of Los Angeles, Los Angeles, CA, (2) Southwest Healthcare MEC, Temecula, CA
Submitting Author:
Markian Bojko
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Heart Institute, Children's Hospital of Los Angeles
Heart Institute, Children's Hospital of Los Angeles
Co-Author(s):
Luke Wiggins
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Heart Institute, Children's Hospital of Los Angeles
Heart Institute, Children's Hospital of Los Angeles
John Cleveland
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Heart Institute, Children's Hospital of Los Angeles
Heart Institute, Children's Hospital of Los Angeles
Ramsey Elsayed
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Southwest Healthcare MEC
Southwest Healthcare MEC
David Cleveland
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Heart Institute, Children's Hospital of Los Angeles
Heart Institute, Children's Hospital of Los Angeles
*Vaughn Starnes
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Heart Institute, Children's Hospital of Los Angeles
Heart Institute, Children's Hospital of Los Angeles
Presenting Author:
Markian Bojko
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Division of Cardiac Surgery, Keck School of Medicine of USC
Division of Cardiac Surgery, Keck School of Medicine of USC
Abstract:
Objective: The Ross procedure has excellent results in the pediatric population. Some series report age and anatomy dependent outcomes, but no comprehensive analysis stratified by these variables exists. We sought to identify the spectrum of congenital heart disease (CHD) treated with the Ross procedure and associated outcomes at our center.
Methods: Over 30 years, 317 pediatric patients underwent the Ross procedure. Patients were stratified into 4 age groups: neonates (<31 days, n=21), infants (31 days-1 year, n=40), children (1-12 years, n=165), and adolescents (13-18 years, n=91). Groups were compared across preoperative variables and outcomes. Multivariable logistic regression identified risk factors for mortality and morbidity. Kaplan-meier method compared survival and freedom from reintervention.
Results: The primary diagnosis was isolated aortic stenosis or regurgitation. Shone's complex 25/317 (8%), interrupted aortic arch (IAA) 20/317 (6%), hypoplastic arch (HA) 20/317 (6%), transposition of the great arteries (TGA) 7/317 (2%), and double outlet right ventricle (DORV) 3/317 (1%) were less common. Operative mortality and major morbidity were 8/21 (38%), 4/40 (10%), 2/165 (1%), 0/91 (0%) and 13/21 (62%), 10/40 (25%), 19/165 (12%), and 5/91 (6%) for ascending age groups (p<0.001, p <0.001). Neonates and infants with isolated aortic valve (AV) disease had an operative mortality of 3% (1/29). In multivariable logistic regression analysis Shone's complex predicted mortality in patients <1 year of age (OR 1.38, p=0.002). Mitral valve disease (OR 1.16, p=0.048) and subvalvular stenosis (OR 1.23, p<0.001) predicted morbidity for children aged 1-12. History of IAA (OR 1.55 p=0.009) predicted morbidity in adolescents. Survival was significantly different between age groups (p<0.001, Figure 1A) and lowest in patients with complex CHD (DORV, TGA, IAA, HA) (Figure 1B, p<0.001). Freedom from left ventricular outflow tract (LVOT) reintervention did not differ between age groups (Figure 1C, p=0.63). Complex CHD demonstrated higher rates of LVOT reintervention (Figure 1D, p=0.004). Multivariable cox regression confirmed this finding (HR 2.47, p=0.03).
Conclusions: Pediatric patients >1 year old and those <1 year old with isolated AV disease have outstanding outcomes after the Ross procedure. Neonates and infants with complex CHD have the highest rates of perioperative morbidity and mortality. Complex CHD is associated with increased risk of LVOT reintervention.
Methods: Over 30 years, 317 pediatric patients underwent the Ross procedure. Patients were stratified into 4 age groups: neonates (<31 days, n=21), infants (31 days-1 year, n=40), children (1-12 years, n=165), and adolescents (13-18 years, n=91). Groups were compared across preoperative variables and outcomes. Multivariable logistic regression identified risk factors for mortality and morbidity. Kaplan-meier method compared survival and freedom from reintervention.
Results: The primary diagnosis was isolated aortic stenosis or regurgitation. Shone's complex 25/317 (8%), interrupted aortic arch (IAA) 20/317 (6%), hypoplastic arch (HA) 20/317 (6%), transposition of the great arteries (TGA) 7/317 (2%), and double outlet right ventricle (DORV) 3/317 (1%) were less common. Operative mortality and major morbidity were 8/21 (38%), 4/40 (10%), 2/165 (1%), 0/91 (0%) and 13/21 (62%), 10/40 (25%), 19/165 (12%), and 5/91 (6%) for ascending age groups (p<0.001, p <0.001). Neonates and infants with isolated aortic valve (AV) disease had an operative mortality of 3% (1/29). In multivariable logistic regression analysis Shone's complex predicted mortality in patients <1 year of age (OR 1.38, p=0.002). Mitral valve disease (OR 1.16, p=0.048) and subvalvular stenosis (OR 1.23, p<0.001) predicted morbidity for children aged 1-12. History of IAA (OR 1.55 p=0.009) predicted morbidity in adolescents. Survival was significantly different between age groups (p<0.001, Figure 1A) and lowest in patients with complex CHD (DORV, TGA, IAA, HA) (Figure 1B, p<0.001). Freedom from left ventricular outflow tract (LVOT) reintervention did not differ between age groups (Figure 1C, p=0.63). Complex CHD demonstrated higher rates of LVOT reintervention (Figure 1D, p=0.004). Multivariable cox regression confirmed this finding (HR 2.47, p=0.03).
Conclusions: Pediatric patients >1 year old and those <1 year old with isolated AV disease have outstanding outcomes after the Ross procedure. Neonates and infants with complex CHD have the highest rates of perioperative morbidity and mortality. Complex CHD is associated with increased risk of LVOT reintervention.
CONGENTIAL:
Aortic valve and aortic root surgery
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