Cardiac reoperations following the Ross procedure in children: spectrum of surgery and reoperation results
OBJECTIVES The Ross procedure is the preferred aortic valve replacement (AVR) choice in small children. Nonetheless, it is a complicated surgery and there are concerns that subsequent cardiac reoperations are exceptionally complex and associated with high morbidity and mortality. We examine the surg...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2012-07, Vol.42 (1), p.25-31 |
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| creator | Alsoufi, Bahaaldin Fadel, Bahaa Bulbul, Ziad Al-Ahmadi, Mamdouh Al-Fayyadh, Majid Kalloghlian, Avedis Siblini, Ghassan Al-Halees, Zohair |
| description | OBJECTIVES
The Ross procedure is the preferred aortic valve replacement (AVR) choice in small children. Nonetheless, it is a complicated surgery and there are concerns that subsequent cardiac reoperations are exceptionally complex and associated with high morbidity and mortality. We examine the surgical spectrum and report outcomes of cardiac reoperations in patients who had undergone the Ross procedure during childhood.
METHODS
Records of 227 consecutive children ( |
| doi_str_mv | 10.1093/ejcts/ezr288 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1023296613</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ejcts/ezr288</oup_id><sourcerecordid>1023296613</sourcerecordid><originalsourceid>FETCH-LOGICAL-c461t-4e00b56ab73082aaab03e8dcd33fc1ed6a8506b840a2c1ca55282eb45a4ea693</originalsourceid><addsrcrecordid>eNp90MtLxDAQBvAgiu-bZ8lF9GDdSdKmqTdZfMGCIB68lWk61S7dpiYton-91V0fJ0-Zw49vJh9jBwLOBGRqQnPbhwm9e2nMGtsWJlVRquLH9XEGAVGaxbDFdkKYA4BWMt1kW1LKDDIB22w-RV_WaLkn15HHvnZt4JVrGvdat0-8fyZ-70LgnXeWysETr1tun-um9NSe89CR7f2w4K7iYfBP5N84tuXfuHEOQ9OHPbZRYRNof_Xusoery4fpTTS7u76dXswiG2vRRzEBFInGIlVgJCIWoMiUtlSqsoJKjSYBXZgYUFphMUmkkVTECcaEOlO77GQZO178MlDo80UdLDUNtuSGkAuQSmZaCzXS0yW1fvyipyrvfL1A_zai_LPc_KvcfFnuyA9XyUOxoPIHf7c5gqMVwGCxqTy2tg6_TkOWCfPpjpfODd3_Kz8A-6SUEg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1023296613</pqid></control><display><type>article</type><title>Cardiac reoperations following the Ross procedure in children: spectrum of surgery and reoperation results</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Alsoufi, Bahaaldin ; Fadel, Bahaa ; Bulbul, Ziad ; Al-Ahmadi, Mamdouh ; Al-Fayyadh, Majid ; Kalloghlian, Avedis ; Siblini, Ghassan ; Al-Halees, Zohair</creator><creatorcontrib>Alsoufi, Bahaaldin ; Fadel, Bahaa ; Bulbul, Ziad ; Al-Ahmadi, Mamdouh ; Al-Fayyadh, Majid ; Kalloghlian, Avedis ; Siblini, Ghassan ; Al-Halees, Zohair</creatorcontrib><description>OBJECTIVES
The Ross procedure is the preferred aortic valve replacement (AVR) choice in small children. Nonetheless, it is a complicated surgery and there are concerns that subsequent cardiac reoperations are exceptionally complex and associated with high morbidity and mortality. We examine the surgical spectrum and report outcomes of cardiac reoperations in patients who had undergone the Ross procedure during childhood.
METHODS
Records of 227 consecutive children (<18 years old) who had undergone the Ross procedure at our institution from 1991 to 2004 were reviewed. Our patient cohort was 50 patients who underwent 58 cardiac reoperations following the Ross procedure during the follow-up. Time-related outcomes were analyzed.
RESULTS
From 1992 to 2009, 50 patients, 37 males (74%), underwent cardiac reoperation at a mean age of 15.6 ± 5.2 years and a mean interval of 3.9 ± 3.0 years following the Ross procedure. Risk factors for cardiac reoperation following the Ross procedure on multivariable analysis were rheumatic fever, aortic regurgitation, concomitant cardiac surgery, use of fresh homografts and earlier era of surgery. Overall, 32 (55%) reoperations were isolated procedures whereas 26 (45%) were more complex involving 2-4 simultaneous cardiac procedures. In total, 92 procedures were performed including AVR (n = 31), homograft replacement (n = 23), mitral valve replacement (n = 18), mitral valve repair (n = 11), tricuspid valve repair (n = 5) and other (n = 4). There was no operative mortality and one late death. Survival was 98% at 10 years. During the follow-up, 8 of 50 patients required further cardiac surgery following initial reoperation with freedom from additional cardiac surgery of 82% at 10 years. Subsequent cardiac surgery risk was higher in patients with pre-operative aortic regurgitation and those who had concomitant surgery at time of Ross on log-rank analysis. Among survivors, 96% are in New York Heart Association class I/II.
CONCLUSIONS
A wide range of cardiac reoperations may be required in children following the Ross procedure, especially those with underlying rheumatic aetiology, aortic regurgitation and multivalvular involvement. Despite complexity, reoperation following the Ross procedure can be performed with low mortality and good mid-term results. This information should be taken into consideration during the selection of aortic valve substitute in children.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezr288</identifier><identifier>PMID: 22290910</identifier><identifier>CODEN: EJCSE7</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adolescent ; Adult ; Aortic Valve Insufficiency - congenital ; Aortic Valve Insufficiency - microbiology ; Aortic Valve Insufficiency - mortality ; Aortic Valve Insufficiency - surgery ; Biological and medical sciences ; Cardiology. Vascular system ; Child ; Child, Preschool ; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava ; Female ; Follow-Up Studies ; Heart ; Humans ; Infant ; Infant, Newborn ; Male ; Medical sciences ; Multivariate Analysis ; Pneumology ; Pulmonary Valve - transplantation ; Reoperation ; Retrospective Studies ; Rheumatic Heart Disease - mortality ; Rheumatic Heart Disease - surgery ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Analysis ; Time Factors ; Transplantation, Autologous ; Treatment Outcome ; Young Adult</subject><ispartof>European journal of cardio-thoracic surgery, 2012-07, Vol.42 (1), p.25-31</ispartof><rights>The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2012</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c461t-4e00b56ab73082aaab03e8dcd33fc1ed6a8506b840a2c1ca55282eb45a4ea693</citedby><cites>FETCH-LOGICAL-c461t-4e00b56ab73082aaab03e8dcd33fc1ed6a8506b840a2c1ca55282eb45a4ea693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,1579,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26099180$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22290910$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alsoufi, Bahaaldin</creatorcontrib><creatorcontrib>Fadel, Bahaa</creatorcontrib><creatorcontrib>Bulbul, Ziad</creatorcontrib><creatorcontrib>Al-Ahmadi, Mamdouh</creatorcontrib><creatorcontrib>Al-Fayyadh, Majid</creatorcontrib><creatorcontrib>Kalloghlian, Avedis</creatorcontrib><creatorcontrib>Siblini, Ghassan</creatorcontrib><creatorcontrib>Al-Halees, Zohair</creatorcontrib><title>Cardiac reoperations following the Ross procedure in children: spectrum of surgery and reoperation results</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>OBJECTIVES
The Ross procedure is the preferred aortic valve replacement (AVR) choice in small children. Nonetheless, it is a complicated surgery and there are concerns that subsequent cardiac reoperations are exceptionally complex and associated with high morbidity and mortality. We examine the surgical spectrum and report outcomes of cardiac reoperations in patients who had undergone the Ross procedure during childhood.
METHODS
Records of 227 consecutive children (<18 years old) who had undergone the Ross procedure at our institution from 1991 to 2004 were reviewed. Our patient cohort was 50 patients who underwent 58 cardiac reoperations following the Ross procedure during the follow-up. Time-related outcomes were analyzed.
RESULTS
From 1992 to 2009, 50 patients, 37 males (74%), underwent cardiac reoperation at a mean age of 15.6 ± 5.2 years and a mean interval of 3.9 ± 3.0 years following the Ross procedure. Risk factors for cardiac reoperation following the Ross procedure on multivariable analysis were rheumatic fever, aortic regurgitation, concomitant cardiac surgery, use of fresh homografts and earlier era of surgery. Overall, 32 (55%) reoperations were isolated procedures whereas 26 (45%) were more complex involving 2-4 simultaneous cardiac procedures. In total, 92 procedures were performed including AVR (n = 31), homograft replacement (n = 23), mitral valve replacement (n = 18), mitral valve repair (n = 11), tricuspid valve repair (n = 5) and other (n = 4). There was no operative mortality and one late death. Survival was 98% at 10 years. During the follow-up, 8 of 50 patients required further cardiac surgery following initial reoperation with freedom from additional cardiac surgery of 82% at 10 years. Subsequent cardiac surgery risk was higher in patients with pre-operative aortic regurgitation and those who had concomitant surgery at time of Ross on log-rank analysis. Among survivors, 96% are in New York Heart Association class I/II.
CONCLUSIONS
A wide range of cardiac reoperations may be required in children following the Ross procedure, especially those with underlying rheumatic aetiology, aortic regurgitation and multivalvular involvement. Despite complexity, reoperation following the Ross procedure can be performed with low mortality and good mid-term results. This information should be taken into consideration during the selection of aortic valve substitute in children.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aortic Valve Insufficiency - congenital</subject><subject>Aortic Valve Insufficiency - microbiology</subject><subject>Aortic Valve Insufficiency - mortality</subject><subject>Aortic Valve Insufficiency - surgery</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Multivariate Analysis</subject><subject>Pneumology</subject><subject>Pulmonary Valve - transplantation</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Rheumatic Heart Disease - mortality</subject><subject>Rheumatic Heart Disease - surgery</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Transplantation, Autologous</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90MtLxDAQBvAgiu-bZ8lF9GDdSdKmqTdZfMGCIB68lWk61S7dpiYton-91V0fJ0-Zw49vJh9jBwLOBGRqQnPbhwm9e2nMGtsWJlVRquLH9XEGAVGaxbDFdkKYA4BWMt1kW1LKDDIB22w-RV_WaLkn15HHvnZt4JVrGvdat0-8fyZ-70LgnXeWysETr1tun-um9NSe89CR7f2w4K7iYfBP5N84tuXfuHEOQ9OHPbZRYRNof_Xusoery4fpTTS7u76dXswiG2vRRzEBFInGIlVgJCIWoMiUtlSqsoJKjSYBXZgYUFphMUmkkVTECcaEOlO77GQZO178MlDo80UdLDUNtuSGkAuQSmZaCzXS0yW1fvyipyrvfL1A_zai_LPc_KvcfFnuyA9XyUOxoPIHf7c5gqMVwGCxqTy2tg6_TkOWCfPpjpfODd3_Kz8A-6SUEg</recordid><startdate>20120701</startdate><enddate>20120701</enddate><creator>Alsoufi, Bahaaldin</creator><creator>Fadel, Bahaa</creator><creator>Bulbul, Ziad</creator><creator>Al-Ahmadi, Mamdouh</creator><creator>Al-Fayyadh, Majid</creator><creator>Kalloghlian, Avedis</creator><creator>Siblini, Ghassan</creator><creator>Al-Halees, Zohair</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120701</creationdate><title>Cardiac reoperations following the Ross procedure in children: spectrum of surgery and reoperation results</title><author>Alsoufi, Bahaaldin ; Fadel, Bahaa ; Bulbul, Ziad ; Al-Ahmadi, Mamdouh ; Al-Fayyadh, Majid ; Kalloghlian, Avedis ; Siblini, Ghassan ; Al-Halees, Zohair</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c461t-4e00b56ab73082aaab03e8dcd33fc1ed6a8506b840a2c1ca55282eb45a4ea693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aortic Valve Insufficiency - congenital</topic><topic>Aortic Valve Insufficiency - microbiology</topic><topic>Aortic Valve Insufficiency - mortality</topic><topic>Aortic Valve Insufficiency - surgery</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Multivariate Analysis</topic><topic>Pneumology</topic><topic>Pulmonary Valve - transplantation</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Rheumatic Heart Disease - mortality</topic><topic>Rheumatic Heart Disease - surgery</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Transplantation, Autologous</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alsoufi, Bahaaldin</creatorcontrib><creatorcontrib>Fadel, Bahaa</creatorcontrib><creatorcontrib>Bulbul, Ziad</creatorcontrib><creatorcontrib>Al-Ahmadi, Mamdouh</creatorcontrib><creatorcontrib>Al-Fayyadh, Majid</creatorcontrib><creatorcontrib>Kalloghlian, Avedis</creatorcontrib><creatorcontrib>Siblini, Ghassan</creatorcontrib><creatorcontrib>Al-Halees, Zohair</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alsoufi, Bahaaldin</au><au>Fadel, Bahaa</au><au>Bulbul, Ziad</au><au>Al-Ahmadi, Mamdouh</au><au>Al-Fayyadh, Majid</au><au>Kalloghlian, Avedis</au><au>Siblini, Ghassan</au><au>Al-Halees, Zohair</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiac reoperations following the Ross procedure in children: spectrum of surgery and reoperation results</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2012-07-01</date><risdate>2012</risdate><volume>42</volume><issue>1</issue><spage>25</spage><epage>31</epage><pages>25-31</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><coden>EJCSE7</coden><abstract>OBJECTIVES
The Ross procedure is the preferred aortic valve replacement (AVR) choice in small children. Nonetheless, it is a complicated surgery and there are concerns that subsequent cardiac reoperations are exceptionally complex and associated with high morbidity and mortality. We examine the surgical spectrum and report outcomes of cardiac reoperations in patients who had undergone the Ross procedure during childhood.
METHODS
Records of 227 consecutive children (<18 years old) who had undergone the Ross procedure at our institution from 1991 to 2004 were reviewed. Our patient cohort was 50 patients who underwent 58 cardiac reoperations following the Ross procedure during the follow-up. Time-related outcomes were analyzed.
RESULTS
From 1992 to 2009, 50 patients, 37 males (74%), underwent cardiac reoperation at a mean age of 15.6 ± 5.2 years and a mean interval of 3.9 ± 3.0 years following the Ross procedure. Risk factors for cardiac reoperation following the Ross procedure on multivariable analysis were rheumatic fever, aortic regurgitation, concomitant cardiac surgery, use of fresh homografts and earlier era of surgery. Overall, 32 (55%) reoperations were isolated procedures whereas 26 (45%) were more complex involving 2-4 simultaneous cardiac procedures. In total, 92 procedures were performed including AVR (n = 31), homograft replacement (n = 23), mitral valve replacement (n = 18), mitral valve repair (n = 11), tricuspid valve repair (n = 5) and other (n = 4). There was no operative mortality and one late death. Survival was 98% at 10 years. During the follow-up, 8 of 50 patients required further cardiac surgery following initial reoperation with freedom from additional cardiac surgery of 82% at 10 years. Subsequent cardiac surgery risk was higher in patients with pre-operative aortic regurgitation and those who had concomitant surgery at time of Ross on log-rank analysis. Among survivors, 96% are in New York Heart Association class I/II.
CONCLUSIONS
A wide range of cardiac reoperations may be required in children following the Ross procedure, especially those with underlying rheumatic aetiology, aortic regurgitation and multivalvular involvement. Despite complexity, reoperation following the Ross procedure can be performed with low mortality and good mid-term results. This information should be taken into consideration during the selection of aortic valve substitute in children.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>22290910</pmid><doi>10.1093/ejcts/ezr288</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of cardio-thoracic surgery, 2012-07, Vol.42 (1), p.25-31 |
| issn | 1010-7940 1873-734X |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aortic Valve Insufficiency - congenital Aortic Valve Insufficiency - microbiology Aortic Valve Insufficiency - mortality Aortic Valve Insufficiency - surgery Biological and medical sciences Cardiology. Vascular system Child Child, Preschool Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava Female Follow-Up Studies Heart Humans Infant Infant, Newborn Male Medical sciences Multivariate Analysis Pneumology Pulmonary Valve - transplantation Reoperation Retrospective Studies Rheumatic Heart Disease - mortality Rheumatic Heart Disease - surgery Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Analysis Time Factors Transplantation, Autologous Treatment Outcome Young Adult |
| title | Cardiac reoperations following the Ross procedure in children: spectrum of surgery and reoperation results |
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