134. The Landscape of Congenital Heart Disease Treated with the Ross Procedure
Presented During: Congenital Rapid Fire Orals
Division of Cardiac Surgery, Keck School of Medicine of USC
Manhattan Beach, CA
United States - Contact Me
Markian Bojko went to Boston College for his undergraduate studies, where he received a B.S. in Physics. He then completed a dual degree MD/MPH program at Drexel University. He currently continues his training as an integrated Cardiothoracic Surgery resident at the University of Southern California. He plans to pursue a career in adult cardiac surgery, and has an interest in aortic and mitral valve surgery.
Sunday, April 28, 2024: 9:58 AM - 10:05 AM
7 Minutes
Metro Toronto Convention Center
Room: Room 716
Description
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.
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
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.
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
Presentation Duration
You will have a 4 minute presentation followed by 3 minutes of discussion from the audience. All presenters must adhere to the presentation and discussion times provided. The AATS will begin to play music once your speaking time is exceeded.