The following is the summary of “Ross procedure in neonates and infants: A valuable operation with defined limits” published in the January 2023 issue of Thoracic and cardiovascular surgery by Cleveland, et al.

When autologous tissue restoration for severe left ventricular outflow tract (LVOT) disease is needed, the Ross method is a valuable approach. Infants and newborns have been shown to be at the greatest risk of mortality in previous studies. To determine which factors most influence clinical outcome, we evaluated data from their institution’s work with this specific group of patients. Researchers reviewed medical records from the past 27 years to determine whether infants and neonates had had Ross procedures here at their hospital. Mortality risk factors and outcomes of survival and readmission were defined by analyzing the full study population.

About 58 patients, with a median age of 63 (range, 9-156) days, underwent a Ross procedure. There were 18 newborns (31%). The hospital had 11 patients who died (19%) before they could release them. Young age (hazard ratio [HR], 1.037;  P=.0045), the presence of the Shone complex (HR, 17.637; P=.009), and the presence of an interrupted aortic arch with a ventricular septal defect (HR, 16.01; P=.031) were all found to be independent predictors of hospital mortality in a multivariate analysis of the entire cohort. Receiving-end-effects-characteristics analysis (area under the curve, 0.752) pinpointed a decrease in survival rates after the age of 84 days. The median follow-up time for the 47 people who made it to the end was 6.7 years (range: 2.1-13.1), and 2 died thereafter. 

The median time for right ventricular outflow tract reintervention was 6 years (range, 2.5-10.3), and 3 patients (6%) required LVOT reintervention at 3, 8, and 17.5 years. For children younger than a year old with aortic valve and/or aortic arch-specific left sided obstructive disease, the Ross surgery can be a life-saving treatment option. Shone and interrupted Aortic Arch/ventricular septal defect(IAA/VSD) patients younger than 3 months old are at increased risk for complications and death. There is a high degree of confidence that patients will not require LVOT reintervention in the intermediate future.

Source: sciencedirect.com/science/article/abs/pii/S0022522322004925