Surgical transition in pediatric aortic valve replacement: Long-Term outcomes of the konno and ross procedures

Objective This study investigated the long-term outcomes of aortic valve replacement for children with left ventricular outflow tract (LVOT) anomaly by the Konno procedure with mechanical valve and by the Ross procedure, and compared the outcomes between the two procedures. Methods This single-institutional retrospective study included 54 children (<18 years old) undergoing the Konno procedure (K-group) and 49 children undergoing the Ross/Ross-Konno procedure (R-group) from 1984 to 2024. Results The median age at operation was 8.3 years in K-group and 10.8 years in R-group (p=.03). During the follow-up of 20.7 years in K-group and 17.5 years in R-group, there were 9 mortalities and 8 reoperations in K group and 3 mortalities and 26 reoperations in R-group. There was no significant difference in actuarial 30-years survival (84.1%; 95%CI [71.1-91.9%] in K-group and 91.0%; 95%CI [73.4-97.4%] in R-group; p=.24). Overall 20-years freedom from reoperation for LVOT and/or right ventricular outflow tract (RVOT) (84.9%; 95%CI [71.4-92.7%] in K-group and 28.5%; 95%CI [12.9-51.6%] in R-group; p<.001) and 20-years freedom from reoperation for LVOT (86.7%; 95%CI [73.2-94.0%] in K-group and 57.4%; 95%CI [37.6-75.1%] in R-group; p=.007) were significantly better in K-group. There were 4 late mortalities among 7 reoperations for LVOT in K-group, while 1 mortality after reoperation for RVOT in R-group. There were 2 cerebrovascular accidents in K-group during the follow-up. Conclusions While there was no significant difference in long-term survival between the Konno procedure and Ross/Ross-Konno procedure, the Ross/Ross-Konno procedure showed higher reoperation rate for LVOT and RVOT.