Left Ventricular Functional Changes after Ross Procedure in Children and Adolescents

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Echocardiography

Background:

• The Ross procedure is a standard aortic valve replacement (AVR) in pediatric and adolescent patients.
• Previous research on Ross AVR outcomes focused on graft function, neglecting early myocardial remodeling effects.
• Early assessment of myocardial remodeling post-Ross AVR is crucial for understanding long-term outcomes.

Purpose of the Study:

• To investigate early global myocardial function and remodeling following the Ross procedure in pediatric and adolescent patients.
• To analyze changes in left ventricular global circumferential strain (LV GCS) and left ventricular global longitudinal strain (LV GLS) post-Ross AVR.
• To determine the predictive role of strain metrics on in-hospital outcomes.

Main Methods:

• Prospective study involving 58 pediatric and adolescent patients undergoing the Ross procedure.
• Comprehensive echocardiography with myocardial strain analysis (LV GCS and LV GLS) at pre-surgery, 3-6 months, and 1-year follow-up.
• Paired comparisons of strain indices at different time points and correlation with hospital stay.

Main Results:

• A significant reduction in LV GCS was observed at 3-6 months post-operation (P < 0.001), with no change in LV GLS (P = 0.186).
• By 1-year follow-up, LV GLS improved significantly compared to the 3-6 month period (P < 0.001) and trended towards baseline improvement (P = 0.124).
• Worse pre-operative LV GLS was associated with a longer median hospital stay (8 vs. 6 days, P = 0.007).

Conclusions:

• The Ross procedure initially impacts LV GCS more than LV GLS in pediatric patients.
• By one year post-procedure, LV GLS shows improvement, while LV GCS remains reduced, indicating potential beneficial left ventricular remodeling.
• Strain analysis provides insights into early myocardial functional changes after Ross AVR in young patients.