Key result
Ross-Konno for complex LVOTO achieves ~70% long-term survival, with poor LV function increasing early mortality.
Why the study?
Long-term follow-up data on the Ross-Konno procedure for complex multilevel LVOTO are scarce, necessitating insights into patient outcomes and selection.
What are the long-term survival and reoperation rates following the Ross-Konno procedure in patients with complex multilevel LVOTO?
Cohort (n=48)
What are the long-term survival and reoperation rates following the Ross-Konno procedure in patients with complex multilevel LVOTO?
The Ross-Konno procedure provides durable relief of LVOTO with acceptable long-term survival, though early mortality is high in patients with impaired LV function and reoperation risk increases over time.
May warrant caution with Ross-Konno in poor LV function; leaves open optimal selection and alternatives in complex LVOTO.
OBJECTIVES: The Ross-Konno procedure is a last resort for patients with complex multilevel left ventricular outflow tract obstruction (LVOTO) often having other cardiovascular anomalies. It is typically preceded by multiple surgeries. Literature is scarce on long-term follow-up series. Therefore, we have reviewed our 20-year experience with this procedure in order to provide insights in patients' outcomes and to optimize patient selection. METHODS: Between January 1995 and December 2014, 48 patients underwent the Ross-Konno procedure. The median age at operation was 12.8 months (range, 11 days to 31 years). Twenty-two (46%) patients were under 1 year of age. Forty-four (92%) patients had undergone a total of 82 previous procedures. Eleven (23%) patients had concomitant surgery, predominantly mitral valve (n = 5) and aortic arch surgery (n = 5). RESULTS: The median follow-up time was 4.3 years (range, 0-20 years). There were 6 (12.5%) early deaths and 4 (8.3%) late deaths. Estimated overall survival at 5, 10 and 15 years was 83, 79 and 70%, respectively. Poor LV function was a risk factor for early mortality (odds ratio = 9.5; 95% confidence interval = 1.4-63.7; P = 0.020). Twelve patients required a total of 29 procedures in 17 reoperations. Five patients required reoperation for autograft failure at a median of 14 years (range, 5-15 years) postoperatively. Estimated freedom from all causes of reoperation at 5, 10 and 15 years was 82, 55 and 30%, respectively. All patients had complete and durable relief of LVOTO. At latest follow-up, 5 patients had a sinus of Valsalva Z-score of 5 or greater. One patient had Grade II autograft insufficiency. CONCLUSIONS: The Ross-Konno procedure is a durable solution for multilevel LVOTO in a highly complex patient population with high incidence of previous procedures. High early mortality rates in patients with impaired left ventricular function emphasize the importance of patient selection. Freedom from reoperation shows a continuous attrition rate. Reoperation for autograft failure may occur late after the Ross-Konno procedure.
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Schneider et al. (2015) conducted a cohort in complex multilevel left ventricular outflow tract obstruction (LVOTO) (n=48). Ross-Konno procedure was evaluated on overall survival at 15 years. The Ross-Konno procedure for complex multilevel LVOTO resulted in an estimated 15-year overall survival of 70%, with poor LV function significantly increasing early mortality risk (OR 9.5; P=0.020).
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