{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T21:14:20Z","timestamp":1793222060887,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ventures\u2014Single Ventricle Research Fund (SVRF) and Single Ventricle Expansion Fund","award":["991414"],"award-info":[{"award-number":["991414"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>Patients with endocardial fibroelastosis (EFE) in the setting of congenital critical aortic valve (AoV) stenosis and left ventricular outflow tract obstruction (LVOTO) are at risk for diastolic dysfunction, limiting biventricular circulation. EFE resection is the only available treatment option, but frequently recurs requiring re-resections. We aimed to investigate whether augmentation of a left ventricular outlet stenosis (AoV stenosis \u00b1 LVOTO) with a Ross\/Ross-Konno procedure prevents EFE recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients born with AoV stenosis \u00b1 LVOTO and treated with primary left ventricular (LV) EFE resection at the study centres from January 2010 to December 2021 were included in the study. The inclusion criteria for this retrospective analysis was the presence or absence of a Ross\/Ross-Konno procedure for the treatment of a modifiable risk factor of EFE recurrence. Retrospective allocation to either the non-Ross or Ross\/Ross-Konno group was carried out accordingly. The primary outcome measure was EFE recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Ninety-three patients were screened, and 60\/93 patients (64.5%) met all inclusion criteria. Within those 60 patients, 5\/23 (20.7%) in the Ross\/Ross-Konno group had EFE recurrence compared to 23\/37 (62.2%) in the non-Ross group [difference\u2009=\u200940.5%, 95% confidence interval (CI) 14.6\u201358.7, P\u2009= \u20090.003] and were less likely to develop EFE recurrence with adjusted hazard ratio of 4.07 (95% CI 1.38\u201312.0, P\u2009= \u20090.011) and 3.69 (95% CI 1.31\u201310.42, P\u2009= \u20090.014) when including death as a competing event.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study found that patients after a Ross\/Ross-Konno procedure were less likely to experience EFE recurrence and reinterventions on the LVOT\/AoV were significantly reduced. However, patient selection and timing of a Ross\/Ross-Konno procedure to prevent EFE recurrence have yet to be identified through prospective trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IRB PROTOCOL NUMBERS<\/jats:title>\n                    <jats:p>IRB-P0038762 approved 4\/29\/2021 (Boston Children\u2019s Hospital) and Ek Nr: 1137\/2023 approved 10\/25\/2023 (Medical Faculty of Johannes Kepler University Linz).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf214","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T07:49:07Z","timestamp":1750924147000},"source":"Crossref","is-referenced-by-count":5,"title":["Eliminating left ventricular outlet stenosis lowers the risk for endocardial fibroelastosis recurrence"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6358-5048","authenticated-orcid":false,"given":"Gregor","family":"Gierlinger","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Boston Children\u2019s Hospital , Boston, MA,","place":["USA"]},{"name":"Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital , Linz,","place":["Austria"]},{"name":"Medical Faculty, Johannes Kepler University Linz , Linz,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Diaz-Gil","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Boston Children\u2019s Hospital , Boston, MA,","place":["USA"]},{"name":"Department of Pediatrics, Boston Children\u2019s Hospital , Boston, MA,","place":["USA"]},{"name":"Department of Pediatrics, Harvard Medical School , Boston, MA,","place":["USA"]},{"name":"Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine , Boston, MA,","place":["USA"]},{"name":"Department of Pediatric Heart Medicine and Adults with Congenital Heart Disease, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Tulzer","sequence":"additional","affiliation":[{"name":"Medical Faculty, Johannes Kepler University Linz , Linz,","place":["Austria"]},{"name":"Children's Heart Center Linz, Department of Pediatric Cardiology, Kepler University Hospital , Linz,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Mair","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital , Linz,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Sames-Dolzer","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital , Linz,","place":["Austria"]},{"name":"Medical Faculty, Johannes Kepler University Linz , Linz,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Saraci","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Boston Children\u2019s Hospital , Boston, MA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7588-7596","authenticated-orcid":false,"given":"Steven J","family":"Staffa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital , Boston, MA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3610-6942","authenticated-orcid":false,"given":"David","family":"Zurakowski","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital , Boston, MA,","place":["USA"]},{"name":"Department of Anesthesia, Harvard Medical School , Boston, MA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7499-7646","authenticated-orcid":false,"given":"Michaela","family":"Kreuzer","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital , Linz,","place":["Austria"]},{"name":"Medical Faculty, Johannes Kepler University Linz , Linz,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Seeber","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital , Linz,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sitaram M","family":"Emani","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Boston Children\u2019s Hospital , Boston, MA,","place":["USA"]},{"name":"Department of Surgery, Harvard Medical School , Boston, MA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro J","family":"del Nido","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Boston Children\u2019s Hospital , Boston, MA,","place":["USA"]},{"name":"Department of Surgery, Harvard Medical School , Boston, 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