# The Ross/Ross-Konno operation in neonates and infants: A salvage strategy and a durable repair

## TL;DR

This study shows the Ross operation is a successful treatment for severe aortic valve disease in very young children, with good midterm results.

## Contribution

The paper presents a single-center experience demonstrating the feasibility and durability of the Ross operation in neonates and infants.

## Key findings

- The Ross operation in neonates and infants showed excellent midterm outcomes with low mortality and reintervention rates.
- A subset of patients who could not be discharged due to residual valve disease successfully underwent salvage Ross procedures.
- Most patients had complex left-sided heart lesions and prior aortic procedures before the Ross operation.

## Abstract

To review a single-center experience of the Ross operation in neonates and infants with severe aortic valve disease.

Retrospective review identified patients younger than age 1 year who underwent Ross operation between 2010 and 2024. Primary outcome was cumulative incidence of death with transplant as a competing risk. Early and midterm outcomes were analyzed, including postoperative complications and reinterventions. A subgroup analysis of patients who remained hospitalized until Ross procedure was performed. Median follow-up was 5.7 years (interquartile range, 2.9-8.8. years).

Twenty-nine patients (5 neonates and 24 infants) underwent the Ross operation, 24 (82.8%) of whom had a Konno procedure. Median age was 3.5 months (interquartile range, 1.1-5.7 months). Median weight was 4.9 kg (interquartile range, 3.9-6.0 kg). Five patients (27.2%) were born with isolated critical aortic stenosis, whereas 24 patients had other complex left-sided lesions. Twenty-five patients (86.2%) had prior aortic or aortic valve procedures: 14 balloon valvuloplasty, 3 open valvotomy, 1 surgical valve repair, 8 interrupted arch repairs, 5 coarctation or arch repairs, and 2 subaortic stenosis repairs. A subset (n = 11) could not be discharged from the hospital, mostly due to residual valve disease after balloon dilation, and underwent salvage Ross. Nineteen patients (65.5%) had concomitant operations. There was 1 in-hospital and 1 late mortality. Two patients required transplant. At follow-up, 1 patient had moderate or greater neoaortic insufficiency requiring reintervention.

The Ross operation can be performed in neonates and infants with excellent midterm outcomes. This operation can be safely offered as an exit strategy in neonates and infants with residual aortic valve disease who are unable to be discharged.