Key result
In children undergoing the Ross-Konno procedure, concomitant mitral valve surgery was associated with lower 5-year survival compared to no mitral valve surgery (56.1% vs 82.5%; HR 2.67; P<.0001).
Why the study?
The Ross-Konno procedure is a technically demanding surgical option for multilevel left ventricular outflow tract obstruction, prompting an assessment of outcomes following the intervention in children.
What are the long-term survival and reintervention outcomes following the Ross-Konno procedure in children, and how does concomitant mitral valve surgery affect survival?
Systematic Review (n=274)
What are the long-term survival and reintervention outcomes following the Ross-Konno procedure in children, and how does concomitant mitral valve surgery affect survival?
Hazard Ratio: 2.67 (95% CI 1.44–4.93)
Absolute Event Rate: 56.1% vs 82.5%
p-value: p=<.0001
The Ross-Konno procedure in children is associated with substantial early mortality and frequent right ventricular outflow tract reinterventions, with significantly worse survival when concomitant mitral valve surgery is required.
Ross-Konno carries substantial early mortality, higher with concomitant mitral surgery; leaves open optimal selection and EFE resection benefit pending prospective studies.
Background: The Ross-Konno procedure is a technically demanding surgical option to treat multilevel left ventricular outflow tract obstruction. Methods: A systematic review with pooled analyses was conducted according to PRISMA criteria on studies published between January 2000 and May 2022 that assessed outcomes following the Ross-Konno intervention in children. Individual patient data were extracted from published Kaplan-Meier curves using digitalization software. Overall survival and freedom from reintervention were assessed by time-to-event approaches. Determinants of one-year survival were investigated by meta-regression analyses. Results: Ten studies with a total population of 274 patients were included. The overall pooled early (≤30 days) survival rate was 86.9% (95% CI [87.6%-78.4%]). Five-year survival rates in patients without and with (N = 50 [18.2%] of 274 total patients) concomitant mitral valve surgery were 82.5% (95% CI [87.6%-77.4%]) versus 56.1% (95% CI [74.1%-38.1%]), hazard ratio 2.67, 95% CI (1.44-4.93), P < .0001. Five- and ten-year freedom from pulmonary autograft reoperation rates were 93.5% and 90.9%, respectively. Five- and ten-year freedom from right ventricular outflow tract reoperation rates were 74.3% and 57.3%, respectively. By meta-regression analysis, resection of endocardial fibroelastosis (N = 32 [11.7%] of 274 total patients) was associated with superior one-year survival ( P = .027). Conclusion: The Ross-Konno procedure is associated with substantial early mortality and gradual attrition thereafter. Mortality is higher in patients with concomitant mitral valve surgery. Resection of endocardial fibroelastosis is associated with superior survival. Right ventricular outflow tract reinterventions are common.
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Dib et al. (2024) conducted a systematic review in Multilevel left ventricular outflow tract obstruction (n=274). Concomitant mitral valve surgery vs. Ross-Konno procedure without concomitant mitral valve surgery was evaluated on Five-year survival (HR 2.67, 95% CI 1.44-4.93, p=<.0001). In children undergoing the Ross-Konno procedure, concomitant mitral valve surgery was associated with lower 5-year survival compared to no mitral valve surgery (56.1% vs 82.5%; HR 2.67; P<.0001).
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