Does the Ross Procedure Effectively Treat and Reverse Cardiac Damage in Young Patients with Prosthetic Aortic Valve Dysfunction?
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0109
Submission Type:
Abstract Submission
Authors:
Eliza Calin (1), Vincent Chauvette (1), Jawad Falih (2), Nabil Dib (3), Philippe Demers (1), Nancy Poirier (4), Pierre-Luc Bernier (4), Ismail Bouhout (1)
Institutions:
(1) Montreal Heart Institute, Montreal, QC, (2) Université de Sherbrooke, Sherbrooke, QC, (3) Marie Lannelongue, Paris, france, (4) CHU Sainte-Justine, Montreal, QC
Submitting Author:
Eliza Calin
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Montreal Heart Institute
Montreal Heart Institute
Co-Author(s):
Vincent Chauvette
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Montreal Heart Institute
Montreal Heart Institute
Jawad Falih
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Université de Sherbrooke
Université de Sherbrooke
Nabil Dib
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Marie Lannelongue
Marie Lannelongue
Philippe Demers
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Montreal Heart Institute
Montreal Heart Institute
Nancy Poirier
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CHU Sainte-Justine
CHU Sainte-Justine
Pierre-Luc Bernier
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CHU Sainte-Justine
CHU Sainte-Justine
Ismail Bouhout
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Montreal Heart Institute
Montreal Heart Institute
Presenting Author:
Eliza Calin
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Abstract:
Objective
This study aims to assess the effectiveness of the Ross procedure in reversing cardiac damage among patients who have previously undergone a prosthetic aortic valve replacement (pAVR) and are presenting with a stenotic dysfunctional prosthesis.
Methods
Patients aged between 18 and 65, who underwent either a Ross procedure (n=32) or a redo pAVR (n=23) due to stenotic structural prosthesis dysfunction, were identified. Those who had undergone other valvular interventions (n=6), coronary artery bypass surgery (n=7), or an AVR using a homograft (n=8) were excluded. In our institutional Ross database, echocardiographic data from the Ross procedure group were prospectively gathered. Echocardiographic data for patients who underwent a redo pAVR were collected retrospectively. The primary endpoint is the assessment of cardiac damage on echocardiogram overtime, categorized into five stages based on the definition by Généreux et al.1 Secondary endpoints included the aortic valve area (AVA), mean aortic gradient (MAG), and left ventricular (LV) mass overtime. The median follow-up duration was 4.7±1.9 years and 70 follow-up echocardiograms were included in the analysis. Echocardiographic data were analyzed using mixed effect models.
Results
A total of 32 Ross procedures and 23 patients with a redo pAVR were included. Of the Ross patients, 17 (53.1%%) had previously undergone a mechanical AVR and had 15 (46.9%) a biological AVR. In the pAVR group, 17 (73.9%) patients had a mechanical prosthesis and 6 (26.1%%) a bioprosthesis implanted. The Ross group was significantly younger (43±12 years vs AVR 58±7 years, p<0.01). Women represented 49% (n=17) of Ross patients and 35% (n=8) of redo-AVR patients (p=0.42). The preoperative LVEF was similar between groups (p=0.45). In both groups, there is a regression of cardiac damage over 5 years (Figure). In the Ross procedure group, n=15 (48.4%) of patients were in stage 0 of cardiac damage, n=4 (12.9%) in stage 1, (n=7) 22.6% in stage 2, n=4 (12.9%) in stage 3 and n=1 (3.2%) in stage 4. At 5 years, 54.5% (n=6) were in stage 0, 27.3% (n=3) in stage 1, 18.2% (n=2) in stage 2 and none in stages 3 and 4. At 5 years, there was no difference in terms of cardiac damage between groups (p=0.23). The post-operative MAG showed a significantly greater change over time in the pAVR group when compared to the Ross group (4±2 mmHg to 3±2 mmHg versus 15±4 to 17±-6 mmHg at 1 and 5 years respectively, p<0.01). Similarly, the AVA demonstrated a significantly greater increase in the pAVR group compared to the Ross group (3.4±0.4 to 3.3±0.7 cm2versus 2.0±0.4 to 1.8±0.4 cm2 at 1 and 5 years respectively, p<0.01). There was no difference observed in the rate of change in LV mass over time (p=0.66).
Conclusions
The pulmonary autograft proves successful in reversing acquired cardiac damage among young patients experiencing prosthetic valve dysfunction. Within this patient group, the Ross procedure demonstrates superior hemodynamic performance compared to prosthetic AVR for up to 5 years postoperatively. However, the long-term clinical implications of this hemodynamic advantage are yet to be established.
This study aims to assess the effectiveness of the Ross procedure in reversing cardiac damage among patients who have previously undergone a prosthetic aortic valve replacement (pAVR) and are presenting with a stenotic dysfunctional prosthesis.
Methods
Patients aged between 18 and 65, who underwent either a Ross procedure (n=32) or a redo pAVR (n=23) due to stenotic structural prosthesis dysfunction, were identified. Those who had undergone other valvular interventions (n=6), coronary artery bypass surgery (n=7), or an AVR using a homograft (n=8) were excluded. In our institutional Ross database, echocardiographic data from the Ross procedure group were prospectively gathered. Echocardiographic data for patients who underwent a redo pAVR were collected retrospectively. The primary endpoint is the assessment of cardiac damage on echocardiogram overtime, categorized into five stages based on the definition by Généreux et al.1 Secondary endpoints included the aortic valve area (AVA), mean aortic gradient (MAG), and left ventricular (LV) mass overtime. The median follow-up duration was 4.7±1.9 years and 70 follow-up echocardiograms were included in the analysis. Echocardiographic data were analyzed using mixed effect models.
Results
A total of 32 Ross procedures and 23 patients with a redo pAVR were included. Of the Ross patients, 17 (53.1%%) had previously undergone a mechanical AVR and had 15 (46.9%) a biological AVR. In the pAVR group, 17 (73.9%) patients had a mechanical prosthesis and 6 (26.1%%) a bioprosthesis implanted. The Ross group was significantly younger (43±12 years vs AVR 58±7 years, p<0.01). Women represented 49% (n=17) of Ross patients and 35% (n=8) of redo-AVR patients (p=0.42). The preoperative LVEF was similar between groups (p=0.45). In both groups, there is a regression of cardiac damage over 5 years (Figure). In the Ross procedure group, n=15 (48.4%) of patients were in stage 0 of cardiac damage, n=4 (12.9%) in stage 1, (n=7) 22.6% in stage 2, n=4 (12.9%) in stage 3 and n=1 (3.2%) in stage 4. At 5 years, 54.5% (n=6) were in stage 0, 27.3% (n=3) in stage 1, 18.2% (n=2) in stage 2 and none in stages 3 and 4. At 5 years, there was no difference in terms of cardiac damage between groups (p=0.23). The post-operative MAG showed a significantly greater change over time in the pAVR group when compared to the Ross group (4±2 mmHg to 3±2 mmHg versus 15±4 to 17±-6 mmHg at 1 and 5 years respectively, p<0.01). Similarly, the AVA demonstrated a significantly greater increase in the pAVR group compared to the Ross group (3.4±0.4 to 3.3±0.7 cm2versus 2.0±0.4 to 1.8±0.4 cm2 at 1 and 5 years respectively, p<0.01). There was no difference observed in the rate of change in LV mass over time (p=0.66).
Conclusions
The pulmonary autograft proves successful in reversing acquired cardiac damage among young patients experiencing prosthetic valve dysfunction. Within this patient group, the Ross procedure demonstrates superior hemodynamic performance compared to prosthetic AVR for up to 5 years postoperatively. However, the long-term clinical implications of this hemodynamic advantage are yet to be established.
Aortic Symposium:
Aortic Surgery Forum (Basic Aortic Research, Venue for Residents, Fellows, Junior Attendings)
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