Left Ventricular Functional Changes after Ross Procedure in Children and Adolescents

The Ross procedure is a well-established method for aortic valve replacement (AVR) in pediatric and adolescent patients. Prior studies investigating morbidity outcomes have focused on autograft and homograft functionality, but no studies have investigated the effect of Ross AVR on early myocardial remodeling. This study investigates early global myocardial function using strain deformation indices in children and adolescents after the Ross AVR. Children and adolescents receiving the Ross procedure underwent pre-surgery, 3-6 month and 1-year follow-up echocardiography involving comprehensive myocardial strain analysis. Specifically, LV global circumferential strain (LV GCS) and LV global longitudinal strain (LV GLS), which is considered to be most susceptible to myocardial injury were assessed. Paired comparison at different stages were assessed along the with the predictive role of strain metrics to in-hospital outcomes. 58 patients who underwent Ross procedure (median age 12.5 years) underwent comprehensive echocardiographic analysis. At the 3-6 month post-operative period, there was a reduction in systolic function as demonstrated by significantly reduced LV GCS (P < 0.001) with no difference in LV GLS (P = 0.186) when compared to pre-operative function. At 1-year follow-up, the LV systolic function as assessed by LV GLS improved when compared to 3-6 month findings (P < 0.001) and trended toward improvement compared to the baseline (P = 0.124). The ratio of GLS / GCS was progressively increased post-operatively (3-6 month, P < 0.001) and (1-year, P < 0.001). Patients with worse pre-operative GLS (>-16%) had higher median hospital stay (median: 6 vs. 8 days, P = 0.007). Initially, after the Ross procedure, GCS is reduced without significant change in GLS. By one year, the function of the longitudinal sub-endocardial fibers is improved, and mid-wall circumferential fiber contractile function remains decreased. Overall, these findings are suggestive of possible beneficial LV remodeling as early as one year after the Ross procedure.