Mid- and Late-term Left Ventricular Diastolic Function After the Ross Procedure

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Pediatric Cardiology

Background:

• The Ross procedure is a common surgical option for congenital aortic valve disease.
• Long-term ventricular mechanics after the Ross procedure are not well understood.
• Evaluating late-term diastolic function is crucial for patient management.

Purpose of the Study:

• To compare the late-term diastolic function of patients who underwent the Ross procedure versus other index surgical repairs for congenital heart lesions.
• To identify factors associated with diastolic dysfunction in Ross procedure patients.

Main Methods:

• Retrospective review of patients undergoing transcatheter pulmonary valve implantation (TPVi) between 2010-2022.
• Comparison of Ross procedure patients with Tetralogy of Fallot (TOF) repair patients and other index congenital heart operation patients.
• Primary outcome: left ventricular end-diastolic pressure (LVEDP); analyzed using univariate and multivariable methods.

Main Results:

• Ross patients had higher LVEDP compared to both TOF and other patient groups (p=0.03).
• Multivariable analysis confirmed significantly higher LVEDP in Ross patients (p<0.01), even after controlling for covariates.
• Ross patients were older at index surgery, had fewer prior surgeries, and were more likely referred for pulmonary stenosis.

Conclusions:

• Ross procedure patients exhibit worse left ventricular diastolic function compared to patients with other index congenital heart operations.
• Impaired diastolic function in Ross patients persists despite fewer prior surgical interventions and older age at index surgery.
• Further research is needed to understand the mechanisms and long-term implications of diastolic dysfunction after the Ross procedure.