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

Preston J Boyer1, Sunkyung Yu2, Ray Lowery2

  • 1Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA. pboyer6@jh.edu.

Pediatric Cardiology
|November 28, 2025
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Summary

Patients undergoing the Ross procedure for congenital aortic valve disease show impaired long-term diastolic function. This study found higher left ventricular end-diastolic pressure in Ross patients compared to other congenital heart surgery repairs.

Keywords:
Aortic valve diseaseCardiac surgical proceduresHeart defects, congenitalVentricular function

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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.