Forty-three patients, with a median age of 6 years, underwent the modified Ross-Konno procedure with a myectomy but without the use of a ventricular septal patch. Serial postoperative echocardiograms (n?=?187) were analyzed, and regression models adjusted for repeated measures were used to model the longitudinal growth of the neoaortic annulus and root.
There were 2 operative deaths (5 % ) and 1 late mortality. At 8 years, survival was 93 % and freedom from autograft, homograft, and all-cause reoperation was 100 % , 81 % , and 72 % , respectively. The median postprocedure diameter and z score were 14 mm (7-21 mm) and +1.3 (?3.0 to +6.1) for the neoaortic annulus and 21 mm (9-30 mm) and +1.6 (?1.3 to +4.1) for the neoaortic root, respectively. Serial echocardiograms showed a progressive increase in annular (+0.56 mm/year, P?<?.001) and root (+0.89 mm/year, P?<?.001) diameters but little change in annular (?0.07/year, P?=?.08) and root (?0.002/year, P?=?.96) z scores. Autograft regurgitation developed in 9 patients; however, the degree and progression of regurgitation over time were not significant (P?=?.22).
After the modified Ross-Konno procedure, the neoaortic annulus and root increased in size proportionately to somatic growth. Autograft regurgitation, usually mild and stable, developed in few patients, and none required autograft reoperation. Our findings support the use of the modified Ross-Konno as the procedure of choice in children with aortic valve disease and complex left ventricular outflow tract obstruction.