CLINICAL RESEARCH: CARDIAC SURGERY FOR CONGENITAL DISEASE
The Relationship Between Neo-Aortic Root Dilation, Insufficiency, and Reintervention Following the Ross Procedure in Infants, Children, and Young Adults
Sara K. Pasquali, MD*,||,
Meryl S. Cohen, MD, FACC*,||,
David Shera, ScD ,||,
Gil Wernovsky, MD, FACC*,||,
Thomas L. Spray, MD ,¶ and
Bradley S. Marino, MD, MPP, MSCE, FACC*, ,||,#,*
* Cardiology
Biostatistics and Epidemiology
Cardiothoracic Surgery
Critical Care Medicine
|| Pediatrics
¶ Surgery
# Anesthesiology and Critical Care at The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Manuscript received September 25, 2006;
revised manuscript received December 20, 2006,
accepted January 9, 2007.
* Reprint requests and correspondence: Dr. Bradley S. Marino, Assistant Professor of Anesthesia and Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, 7th Floor Main, 34th Street and Civic Center Boulevard, Philadelphia, Pennsylvania 19104. (Email: marino{at}email.chop.edu).
Presented in part at the American Heart Association 2005 Scientific Session.
Objectives: The purpose of this study was to describe the relationship between neo-aortic root size, neo-aortic insufficiency (AI), and reintervention at mid-term follow-up.
Background: Data on neo-aortic valve function and growth after the Ross procedure in children are limited.
Methods: A total of 74 of 119 Ross patients from January 1995 to December 2003 had  2 follow-up echocardiograms at our institution and were included. Neo-aortic dimensions were converted to z-scores and modeled over time. Kaplan-Meier analysis was used to assess freedom from neo-aortic outcomes, and predictors were identified through multivariate analysis.
Results: Median age at Ross was 9 years (range 3 days to 34 years). Over 4.7 years (range 3 months to 9.3 years) follow-up, there was disproportionate enlargement of the neo-aortic root (z-score increase of 0.75/year [p < 0.0001]). Neo-AI progressed 1 grade in 36% of patients and 2 grades in 15%. Nine patients (12%) had neo-aortic reintervention at 2.0 years (range 1.1 to 9.5 years) after the Ross procedure owing to severe neo-AI (n = 7), neo-aortic root dilation (n = 1), and neo-aortic pseudoaneurysm (n = 1). At 6 years after the Ross procedure, freedom from neo-aortic reintervention was 88%. Freedom from neo-aortic root z-score >4 was only 3% and from moderate or greater neo-AI was 60%. Longer follow-up time was associated with neo-aortic root dilation (p < 0.0001). Prior ventricular septal defect (VSD) repair predicted neo-AI (p = 0.02) and reintervention (p = 0.03). Prior aortic valve replacement (p = 0.002) also predicted neo-AI. Neo-aortic root dilation was not associated with neo-AI or reintervention.
Conclusions: At mid-term follow-up after the Ross procedure, neo-aortic root size increases significantly out of proportion to somatic growth, and neo-AI is progressive. Prior VSD repair and aortic valve replacement were associated with neo-AI and reintervention.
|
Abbreviations and Acronyms
| | AI = aortic insufficiency | | LV = left ventricular | | VSD = ventricular septal defect |
|
This article has been cited by other articles:
|
|
|
|
 
J. Horer, T. Hanke, U. Stierle, J. J.M. Takkenberg, A. J.J.C. Bogers, W. Hemmer, J. G. Rein, R. Hetzer, M. Hubler, D. R. Robinson, et al.
Neoaortic root diameters and aortic regurgitation in children after the ross operation.
Ann. Thorac. Surg.,
August 1, 2009;
88(2):
594 - 600.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Alsoufi, C. Manlhiot, B. W. McCrindle, C. C. Canver, A. Sallehuddin, S. Al-Oufi, M. Joufan, and Z. Al-Halees
Aortic and mitral valve replacement in children: is there any role for biologic and bioprosthetic substitutes?
Eur. J. Cardiothorac. Surg.,
July 1, 2009;
36(1):
84 - 90.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Alsoufi, Z. Al-Halees, C. Manlhiot, B. W. McCrindle, M. Al-Ahmadi, A. Sallehuddin, C. C. Canver, Z. Bulbul, M. Joufan, and B. Fadel
Mechanical valves versus the Ross procedure for aortic valve replacement in children: Propensity-adjusted comparison of long-term outcomes.
J. Thorac. Cardiovasc. Surg.,
February 1, 2009;
137(2):
362 - 370.e9.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. E. David
Ross Procedure at the Crossroads
Circulation,
January 20, 2009;
119(2):
207 - 209.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. de Kerchove, J. Rubay, A. Pasquet, A. Poncelet, C. Ovaert, M. Pirotte, M. Buche, W. D'Hoore, P. Noirhomme, and G. El Khoury
Ross Operation in the Adult: Long-Term Outcomes After Root Replacement and Inclusion Techniques
Ann. Thorac. Surg.,
January 1, 2009;
87(1):
95 - 102.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Frigiola, M. Ranucci, C. Carlucci, A. Giamberti, R. Abella, and M. Di Donato
The Ross Procedure in Adults: Long-Term Follow-Up and Echocardiographic Changes Leading to Pulmonary Autograft Reoperation
Ann. Thorac. Surg.,
August 1, 2008;
86(2):
482 - 489.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Carrel, M. Schwerzmann, F. Eckstein, T. Aymard, and A. Kadner
Preliminary results following reinforcement of the pulmonary autograft to prevent dilatation after the Ross procedure.
J. Thorac. Cardiovasc. Surg.,
August 1, 2008;
136(2):
472 - 475.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. K. Pasquali, B. S. Marino, J. R. Kaltman, A. J. Schissler, G. Wernovsky, M. S. Cohen, T. L. Spray, and R. E. Tanel
Rhythm and Conduction Disturbances at Midterm Follow-up After the Ross Procedure in Infants, Children, and Young Adults
Ann. Thorac. Surg.,
June 1, 2008;
85(6):
2072 - 2078.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. A. Bacha
Invited Commentary
Ann. Thorac. Surg.,
March 1, 2008;
85(3):
808 - 809.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. A. Bacha, D. B. McElhinney, K. J. Guleserian, S. D. Colan, R. A. Jonas, P. J. del Nido, and G. R. Marx
Surgical aortic valvuloplasty in children and adolescents with aortic regurgitation: Acute and intermediate effects on aortic valve function and left ventricular dimensions
J. Thorac. Cardiovasc. Surg.,
March 1, 2008;
135(3):
552 - 559.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Elshershari, J. G. Gossett, and Z. M. Hijazi
Percutaneous Closure of Left Ventricular Pseudoaneurysms After Ross Procedure
Ann. Thorac. Surg.,
February 1, 2008;
85(2):
634 - 636.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
