TY - JOUR
T1 - Ross Procedure in Children
T2 - The Society of Thoracic Surgeons Congenital Heart Surgery Database Analysis
AU - Rowe, Georgina
AU - Gill, George
AU - Zubair, M. Mujeeb
AU - Roach, Amy
AU - Egorova, Natalia
AU - Emerson, Dominic
AU - Habib, Robert H.
AU - Bowdish, Michael E.
AU - Chikwe, Joanna
AU - Kim, Richard W.
N1 - Funding Information:
Dr Roach is supported by a grant from the National Institutes of Health, National Heart, Lung and Blood Institute for advanced heart disease research (T32HL116273).
Funding Information:
The data for this research were provided by The Society of Thoracic Surgeons National Database Participant User File Research Program. Data analysis was performed at the investigators’ institution. Dr Roach is supported by a grant from the National Institutes of Health, National Heart, Lung and Blood Institute for advanced heart disease research (T32HL116273). The authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2023 The Society of Thoracic Surgeons
PY - 2023/1
Y1 - 2023/1
N2 - Background: Single-center studies have demonstrated excellent results for the Ross procedure in children. We aimed to evaluate national variation in clinical outcomes using The Society of Thoracic Surgeons Congenital Heart Surgery Database. Methods: The database was used to identify 2805 children undergoing the Ross procedure from 2000 through 2018, comprising 163 neonates (<30 days, 5.8%), 448 infants (30-365 days, 16.0%), 1444 children (1-12 years, 51.5%), and 750 teenagers (13-17 years, 26.7%). Centers were divided into terciles by procedural volume. Multivariable logistic regression was used to identify predictors of a composite outcome of operative mortality, neurologic deficit, or renal failure requiring dialysis. Results: Neonates and infants were more likely to present with aortic stenosis than children and teenagers (61.7% [n = 377] vs 34.6% [n = 760]; P < .01) and have risk factors including preoperative shock (9.2% [n = 56] vs 0.4% [n = 8]; P < .01). Operative mortality was 24.1% (n = 39) in neonates, 11.2% (n = 50) in infants, 1.5% (n = 21) in children, and 0.8% (n = 6) in teenagers (P < .01). Independent predictors of the composite outcome in children aged <1 year included neonatal age (odds ratio [OR], 3.0; 95% CI, 1.9-4.8), low-volume center (OR, 2.1; 95% CI, 1.1-3.9), and procedure year (OR, 0.7; 95% CI, 0.5-0.9 per 5 years). In children aged ≥1 year, no association was found between center volume, procedure year, and outcome. Conclusions: The Ross procedure is being performed with low mortality in children aged ≥1 year throughout North America. High-volume centers have improved outcomes in children aged <1 year, who have different anatomic characteristics and risk profiles.
AB - Background: Single-center studies have demonstrated excellent results for the Ross procedure in children. We aimed to evaluate national variation in clinical outcomes using The Society of Thoracic Surgeons Congenital Heart Surgery Database. Methods: The database was used to identify 2805 children undergoing the Ross procedure from 2000 through 2018, comprising 163 neonates (<30 days, 5.8%), 448 infants (30-365 days, 16.0%), 1444 children (1-12 years, 51.5%), and 750 teenagers (13-17 years, 26.7%). Centers were divided into terciles by procedural volume. Multivariable logistic regression was used to identify predictors of a composite outcome of operative mortality, neurologic deficit, or renal failure requiring dialysis. Results: Neonates and infants were more likely to present with aortic stenosis than children and teenagers (61.7% [n = 377] vs 34.6% [n = 760]; P < .01) and have risk factors including preoperative shock (9.2% [n = 56] vs 0.4% [n = 8]; P < .01). Operative mortality was 24.1% (n = 39) in neonates, 11.2% (n = 50) in infants, 1.5% (n = 21) in children, and 0.8% (n = 6) in teenagers (P < .01). Independent predictors of the composite outcome in children aged <1 year included neonatal age (odds ratio [OR], 3.0; 95% CI, 1.9-4.8), low-volume center (OR, 2.1; 95% CI, 1.1-3.9), and procedure year (OR, 0.7; 95% CI, 0.5-0.9 per 5 years). In children aged ≥1 year, no association was found between center volume, procedure year, and outcome. Conclusions: The Ross procedure is being performed with low mortality in children aged ≥1 year throughout North America. High-volume centers have improved outcomes in children aged <1 year, who have different anatomic characteristics and risk profiles.
UR - http://www.scopus.com/inward/record.url?scp=85136720899&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2022.06.043
DO - 10.1016/j.athoracsur.2022.06.043
M3 - Article
C2 - 35870519
AN - SCOPUS:85136720899
SN - 0003-4975
VL - 115
SP - 119
EP - 125
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -