Rhythm and conduction disturbances at midterm follow-up after the ross procedure in infants, children, and young adults

Background. To our knowledge, late electrophysiologic outcomes after the Ross procedure have not been described. The purpose of this study was to assess rhythm and conduction disturbances at midterm follow-up after the Ross procedure. Methods. A cross-sectional analysis of Ross procedure survivors ( January 1, 1995 to December 31, 2005) followed at our institution was performed, including resting and 24-hour ambulatory electrocardiography ( Holter monitoring). Rhythm and conduction disturbances were described, and predictors of arrhythmia were identified. Results. Of 64 eligible patients, 47 ( 71%) participated. Median age at surgery was 8.7 years ( age range, 34 days to 34 years). Twenty-five patients (53%) had isolated aortic valve disease and 22 (47%) had complex left-sided heart disease. At median follow-up of 8.9 years (range, 2.6-11.1 years), 46 patients (98%) exhibited sinus rhythm. Sinus node dysfunction (SND), defined as a pause of 2 seconds or longer or bradycardia for age, was present in 7 patients (15%). Complete heart block requiring a pacemaker occurred in 2 patients (4%). Ventricular tachycardia (VT) was present in 7 patients (15%), including nonsustained VT in 5 patients on Holter monitoring, and sustained VT in 2 patients requiring defibrillator placement. In multi-variate analysis, concurrent arch repair at the time of the Ross operation(p=0.04), longer cross-clamp time at the time of Ross operation (p=0.04), and right ventricular outflow tract obstruction on follow-up echocardiogram (p=0.03) were associated with SND. Longer cross-clamp time ( p=0.03) was also associated with VT, along with older age at surgery (p=0.06 for trend). Conclusions. At midterm follow-up after the Ross procedure, rhythm and conduction disturbances occur in one third of patients, including SND in 15%, atrioventricular block in 4%, and VT in 15%. Routine surveillance for late arrhythmias after the Ross procedure is warranted.