Ross-Konno Procedure in Infants and Neonates

Objectives: The objective of this study was to analyze our midterm results of the Ross-Konno procedure in newborn and infants.

Methods: Twenty-seven children with severe left ventricular outflow tract (LVOT) obstruction underwent Ross-Konno procedure between 10/2000 and 04/2013. Twenty-four patients were ≤3 months old (median: 17 d; 79 d) at the time of operation. Fourteen patients had a borderline left ventricle. Median weight was 3.18 (2.7; 4.2)kg. Prenatal interventions were performed in n= 7 and postnatal interventions in n= 18. Ten patients required multiple concomitant procedures (VSD closure: n= 3, aortic arch reconstruction: n= 9, EFE resection: n= 3).

Results: There were three deaths at 18, 37, and 38 postoperative days, n= 2 by sepsis and n= 1 because of severe mitral stenosis and EFE. Actuarial survival is 88% at 137 months follow-up. Postoperatively, n= 2 required ECMO, n= 1 required MV replacement, n= 1 required redo aortic arch reconstruction, n= 9 required redo RV-PA-conduit implantation, and n= 2 required a permanent pacemaker. Echocardiographic follow-up revealed no LVOT stenosis with no aortic insufficiency > grade I. At 3 years postoperatively, median FS was 28% (22 – 34), Z-scores of aortic valve diameter: median +1.92 (– 0.6 – 2.94), and of the aortic sinus +2.77 (0.79 – 4.51).

Conclusions: In neonates and infants with critical LVOT stenosis and non-effective interventional treatment, early Ross-Konno procedure seemed to be a good option regarding aortic valve and LV function. Progressive dilatation of aortic sinus did occur and must be monitored in the long term!