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Midterm results of the Ross procedure in children: an appraisal of the subannular implantation with interrupted sutures technique

Phan-Kiet, T; Tsang, VT; Cornejo, PR; Torii, R; Dominguez, T; Tran-Lundmark, K; Hsia, T-Y; ... Kostolny, M; + view all (2017) Midterm results of the Ross procedure in children: an appraisal of the subannular implantation with interrupted sutures technique. European Journal of Cardio-Thoracic Surgery , 52 (4) pp. 798-804. 10.1093/ejcts/ezx113. Green open access

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Abstract

OBJECTIVES: The support of the pulmonary autograft root by the fibromuscular left ventricular outflow tract is emphasized to address the concern related to the dilatation of the pulmonary autograft structures in the paediatric population. METHODS: This retrospective study analyses the outcomes of 75 children who were operated between 1998 and 2012 with the subannular interrupted sutures technique at a median age of 10.2 years (range, 5.3 months–18.0 years). Median follow-up time was 5.2 years (range, 3 days–13.2 years). RESULTS: There were no deaths, but there were 3 reinterventions on the autograft for regurgitation and 2 resections of left ventricular outflow tract obstruction. There was no significant autograft stenosis, and freedom from moderate-to-severe regurgitation was 95% (95% confidence interval: 89–100) and 88% (95% confidence interval: 77–99) at 5 and 10 years, respectively. Median z-scores at the latest follow-up examination were, at the annulus, 0.31 [interquartile range (IQR) = −0.81 to 1.2]; at the sinus of Valsalva, 2.7 (IQR = 1.5–3.5); and at the sinotubular junction, 3.1 (IQR = 1.7–4.2). The correlation between z-scores and time after the operation was negative at the level of the annulus (r = −0.29, P = 0.034) but positive at the level of the sinus (r = +0.37, P = 0.005) and the sinotubular junction (r = +0.26, P = 0.068). The median rate of change in the z-score at the annulus was low, 0.065 z-score/year (IQR = −0.13 to 0.43). CONCLUSIONS: The subannular interrupted sutures implantation technique is associated with acceptable risks and, in the midterm, delivers limited annular dilatation, autograft regurgitation and delayed need for autograft reintervention.

Type: Article
Title: Midterm results of the Ross procedure in children: an appraisal of the subannular implantation with interrupted sutures technique
Location: Orlando, FL
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/ejcts/ezx113
Publisher version: https://doi.org/10.1093/ejcts/ezx113
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Ross, Left ventricular outflow tract obstruction, Aortic root, Subannular, Congenital aortic stenosis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering
URI: https://discovery.ucl.ac.uk/id/eprint/1555148
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