The Ross/Konno procedure in neonates and infants: Intermediate-term survival and autograft function

Background. The Ross procedure has been increasingly applied to neonates an d infants. Addition of a modified Konno-type enlargement of the aortic annu lus allows the application of this procedure to neonates and infants with s ignificant annular hypoplasia. The potential for growth and the proven dura bility make the autograft an ideal aortic valve replacement. Methods. Between March 1993 and December 2000, 10 patients under 1 year of age underwent a Ross/Konno procedure at our institution (range, 2 to 349 da ys; median 16). All patients had severe to critical aortic stenosis. All pa tients required aortic annulus enlargement for size mismatch between the ao rtic and pulmonary valves. Results. There were no deaths at a median follow-up of 48 months (range, 1 to 74 months). All patients had none to mild aortic stenosis on Doppler ech ocardiography. Eight patients had a 0 to 1+ aortic insufficiency, 1 patient had a 2+ aortic insufficiency, and I patient had a 3+ aortic insufficiency . Aortic annular dilatation was not observed. Aortic sinus dilatation occur red initially (mean change in z-value: 0 to 12 months, +2.1) and then stabi lized (mean change in z-value: 12 to > 36 months, +0.6). No patient require d additional procedures for aortic valve disease. Two patients required thr ee pulmonary allograft replacements. Conclusions. The Ross procedure with a modified Konno-type enlargement of t he aortic annulus is an excellent approach to aortic valve disease in the n eonate and infant. The procedure can be accomplished with low morbidity and mortality, and low rates of reoperation. The pulmonary auto-raft demonstra tes durability without developing aortic stenosis, aortic insufficiency, or progressive dilatation. Enlargement of the aortic annulus parallels somati c growth. (C) 2001 by The Society of Thoracic Surgeons.