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Ann Thorac Surg 1998;66:1383-1388
© 1998 The Society of Thoracic Surgeons
a Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
b Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
c Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
d Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
Accepted for publication April 25, 1998.
Address reprint requests to Dr Rhodes, Division of Cardiology, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104
e-mail: (rhodes{at}Email.chop.edu)
Background. The Ross procedure is performed for a variety of left ventricular outflow tract diseases in children. The preoperative hemodynamic burden of pressure or volume overload and associated ventricular hypertrophy can predispose to ventricular arrhythmias. Additional procedures performed with the Ross procedure (eg, Konno) may damage the conduction system.
Methods. Between January 1995 and February 1997, the Ross procedure was performed in 42 patients, 31 (74%) of whom had 71 prior interventions. Concomitant procedures (n = 42 in 23 patients) included 17 annular-enlarging procedures. Screening was performed for perioperative conduction and rhythm abnormalities.
Results. There was one postoperative death. Perioperative ventricular tachycardia occurred in 12 patients (29%), with 2 receiving antiarrhythmic medication for ventricular tachycardia at discharge. Transient complete heart block occurred in 3 patients, all of whom had concomitant procedures performed in the subaortic area; all patients were discharged in sinus rhythm and no patient received a permanent pacemaker.
Conclusions. The Ross procedure can be performed successfully in children with complex cardiac disease with low mortality and perioperative morbidity. The incidence of perioperative ventricular tachycardia is high (29%), suggesting the need for vigilant perioperative monitoring and long-term surveillance.
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