Quantitative and Functional Assessment of Both Ventricles after Ross Procedure versus Conventional Aortic Valve Surgery

Background: The Ross procedure is well-established for aortic valve diseases (AVD) with excellent long-term outcomes in young and middle-aged patients. However, there is limited knowledge on quantitative and functional changes of left (LV) and right ventricle (RV) after Ross procedure.

Methods: We enrolled 38 patients who aged 18 or older and underwent Ross procedure between 2016 and 2023 with high-quality echocardiograms. Using propensity score matching (PSM) regarding age, gender, NYHA classification, and AVD (regurgitation, stenosis, or combined), we identified 19 pairs with patients who underwent conventional aortic valve replacement or repair (AVR) during the same period. The echocardiographic characteristics, including speckle-tracking echocardiography (STE), were evaluated and compared pre-, postoperatively, and at 3-month follow up (FU3m).

Results: After PSM, both groups (Ross vs. AVR) exhibited comparable pathophysiology of AVD, and preoperative NYHA classifications. LV ejection fraction (EF), indexed LV end-systolic volume and end-diastolic volume did not differ significantly between the groups at all timepoints. Although LV global longitudinal strain (GLS) were comparable at baseline and direct postoperatively, it improved significantly in Ross group compared to AVR group at FU3m (-19.0 ± 2.6% vs. -15.9 ± 3.8%, p = 0.018). The postoperative mean gradient of aortic valve was lower in Ross than AVR group (5.1 ± 3.1 vs. 9.6 ± 4.9 mmHg, p = 0.002), and this advantage persisted at FU3m (4.5 ± 2.2 vs. 9.3 ± 2.7 mmHg, p < 0.001). The RV quantitative parameters were comparable at all time points except for elongated longitudinal dimension in Ross group at FU3m (77.4 ± 9.6 vs. 70.0 ± 9.4 mm, p = 0.043). Functionally, the tricuspid annular plane systolic excursion (TAPSE) was significantly reduced in Ross group (12.3 ± 2.4 vs. 15.5 ± 3.1 mm, p = 0.001), but recovered at FU3m (17.0 ± 3.0 vs. 18.4 ± 4.4 mm, p = 0.363), while the RV fractional area, and free wall longitudinal strain remained comparable at all timepoints.

Conclusion: Comparing Ross procedure to conventional aortic valve surgery, there is no evidence of inferior RV function, except for a temporary reduction in TAPSE immediately after surgery. LV function and structure are similar between the two procedures, with an improvement in GLS three months after Ross procedure. This improvement may be attributed to the favorable hemodynamics of autograft, resulting from reduced pressure gradients associated with native valve.

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Artikel online veröffentlicht:
13. Februar 2024