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

The Ross procedure is a common surgical option for congenital aortic valve disease, but little is understood about the long-term ventricular mechanics of patients who undergo the Ross procedure. This study evaluated the late-term diastolic function of Ross patients compared to patients who underwent other types of index surgical repairs for congenital heart lesions. Patients who underwent catheterization for transcatheter pulmonary valve implantation (TPVi) at a single center between 2010 and 2022 were retrospectively reviewed. Patients who had undergone a Ross procedure were compared to those who had undergone Tetralogy of Fallot (TOF) repair and other index congenital heart operations. The primary outcome was left ventricular end diastolic pressure (LVEDP). Ross patients, TOF patients, and all others were compared in both univariate and multivariable analyses. Of 250 patients, 33 (13%) had prior Ross and 143 (57%) had prior TOF repair. Compared to other patients, Ross patients were larger at the time of catheterization (p < 0.01), more likely referred for pulmonary stenosis (vs. insufficiency or mixed) (p = 0.03), had fewer previous surgeries (p < 0.0001), and were older at their index cardiac surgery (p < 0.0001). Ross patients had significantly higher LVEDP than both TOF and other patients (p = 0.03). In multivariable analysis, higher LVEDP in Ross patients remained significant (p < 0.01) when controlling for age and RVEDP at the time of catheterization and reason for TPVi referral. Despite fewer prior surgical interventions and older age at time of index surgery, Ross patients have worse LV diastolic function compared to patients with other index congenital heart operations.