Ross–Konno Procedure in Patients with Critical Aortic Stenosis and Borderline Left Ventricle—Are the Scores Still Applicable?

Background: In critical LVOT obstruction, there are few prognostic scores for decision making between univentricular and biventricular repair: Rhodes-, Discriminant-, CHSS1- and CHSS2-Score. In the underlying studies the usual type of biventricular repair was either surgical or balloon valvuloplasty. The Ross–Konno operation changes the LVOT substantially and so some of the scores’ parameters. The purpose of this study is to examine if these scores are still applicable if a Ross–Konno procedure is used.

Methods: Between January 2010 and December 2021, 51 pts with critical LVOT obstruction and borderline LV were treated at our center. In 37 pts a biventricular repair was initially pursued and in 14 pts univentricular repair. A retrospective single-center investigation was carried out to evaluate all four scores. As second part of our investigation the scores were calculated with proposed postoperative dimensions, by replacing all LVOT dimensions with the pulmonary root diameter.

Results: 31 pts (84%) of our Ross–Konno cohort maintained a successful BVR. Perioperative mortality: 4 pts (10.8%). Conversion to UVR: 2 pts (5.4%). 11 pts (79%) in our Norwood cohort maintained a successful UVR. Perioperative mortality: 3 pts (21%). There were significant differences (p < 0.005) between the two cohorts: MV diameter, AV diameter, aortic root diameter, ascending aorta diameter, heart LAX and LV length. The Rhodes score predicted a different pathway in 27 of 42 successfully treated pts, the Discriminant score in 15 of 42 pts, the CHSS-1 score in 26 of 42 pts and the CHSS-2 score in 24 of 42 pts.

Adaption with the pulmonary autograft dimensions leads to higher sensitivity, regarding a BVR, in all scores but result in lower specificity (see table).

Score	Sens. (%)	Sens. Mod. (%)	Spec. (5)	Spec. Mod(%)
Rhodes	11.43	45.71	100	75
Discriminant	54.29	100	75	0
CHSS-1	43.75	75	62.86	40
CHSS-2	50	81.27	57.14	37.14

Conclusion: The validity of these scores, in Ross–Konno patients with critical aortic stenosis and borderline left ventricle, is limited.

Calculating the scores with the proposed changes after Ross–Konno procedure may result in a too large shift towards biventricular repair and an unacceptable loss of specificity.

Publication History

Article published online:
13 February 2024