AORTIC STENOSIS IN INFANTS: SUCCESS AND CHALLENGES OF THE ROSS-KONNO PROCEDURE

Background and Aim: Aortic stenosis in infants demands a safe and durable solution. Ross-Konno procedure offers a promising alternative. The aim of this research was to describe the results following Ross-Konno procedure conducted on infants. Methods: This study retrospectively analyzed outcomes of Ross-Konno in 14 infants younger than 1year, between December 2009 and July 2023. Patients were followed up to a median of 2.07 years (IQR: 0.8- 4.1). Primary outcomes measured included survival rates, morbidity, reintervention, mid-term functional and echocardiographic assessments. Results: Median age at operation was 98 days (IQR: 60-145), median weight was 5 kg (IQR: 4.3-6). Eleven patients (78%) had undergone prior procedures, balloon valvuloplasty in (64%). Median CPB time was 189 minutes (IQR: 180-198), median aortic cross-clamp time was 142 minutes (IQR: 129-157). Six patients required concomitant mitral valve surgery or aortic arch reconstruction. There was one early death, a neonate weighing 2.8 kg; one late death at 4 years of age. Freedom from reoperation on autograft was 100% at 1 year, 93% at 5 years. One aortic root replacement was performed 4 years after Ross-Konno in infancy. Three pulmonary conduits required reintervention (21%). Neoaortic Z-scores remained consistent from 4 weeks after procedure to the most recent follow-up. Two patients needed permanent pacemaker due to complete heart block. Conclusions: Ross-Konno procedure serves as viable primary solution for aortic stenosis in infants, offering durable and high-quality outcomes. With precise surgical technique, it effectively establishes robust LVOT and reduces likelihood of future reinterventions. Despite potential for significant complications, this procedure provides excellent survival rates, stable neoaortic function, and preserved ventricular performance.