P189. Left Ventricle Strain Evaluation by Cardiovascular Magnetic Resonance Imaging in Patients Undergoing the Ross Procedure versus Mechanical Aortic Valve Replacement
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Mount Sinai Hospital
New York, NY
United States - Contact Me
Senior cardiac surgery resident at Montreal University. Currently pursuing a PhD in biomedical sciences. Main interests are in root surgery, aortic surgery and epidemiology.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Several studies have demonstrated better survival after aortic valve replacement (AVR) with a pulmonary autograft (Ross procedure) compared with a mechanical prosthesis. This study aims to compare resting and peak exercise left ventricle (LV) strain by cardiovascular magnetic resonance (CMR) in patients who underwent a Ross procedure versus a mechanical AVR.
Methods: A total of 40 patients were enrolled (20 with a previous Ross procedure and 20 with a previous mechanical AVR). Participants were previously screened and matched in a 1:1 ratio based on several preoperative characteristics. All patients underwent exercise stress CMR examination (MR ergometer, Lode, Netherlands). Measurements of LV strain were calculated using a dedicated software (Circle: Cardiovascular Imaging, Calgary, Alberta, Canada).
Results: Baseline characteristics were similar between both groups, with a mean age of 54±11 and 52±11 years in the Ross and mechanical AVR groups, respectively (p=0.60). There were 3 females in the Ross group and 2 in the mechanical AVR group (p=0.99). The time interval between CMR and surgery did not differ between the groups (4±2 years in both cases, p=0.50). LV strain measurements were obtained from all except 1 patient (mechanical AVR) who had suboptimal image quality. Resting LVEF (57±6% vs 59±8%, p=0.22), heart rate (68±13 bpm vs 67±9 bpm, p= 0.98), indexed end-systolic volumes (35±11 mL/m2 vs 34±11 mL/m2, p=0.38), and end-diastolic volumes (80±22 mL/m2 vs 81±14 mL/m2, p=0.43) did not differ between groups. Peak exercise was similar between the Ross and mechanical AVR groups (6.6±1.8 kcal/kg/h vs 6.8±1.7 kcal/kg/h, p=0.77). Global longitudinal strain (GLS) was similar at rest (-14±2% vs -14±2%, p=0.75) but was significantly improved in the Ross group at peak exercise (Figure 1, p= 0.03 for difference in slopes). Furthermore, the proportion of patients reaching normal GLS values at peak exercise was greater in the Ross group (Figure1, from 10% to 65%, p<0.01) when compared with mechanical AVR (from 10% to 35%, p=0.07). Similar findings were observed in analyzing radial long-axis ([Ross: 15% to 80%, p<0.01] vs [mechanical AVR: 30% to 45%, p=0.45]) and radial short-axis strain ([Ross: 60% to 95%, p<0.01] vs [mechanical AVR: 65% to 70%, p=0.13]). Peak exercise circumferential strain was similar between the 2 groups. There was no statistical difference in the number of patients reaching normal circumferential strain values at peak exercise ([Ross: 10% to 25%, p=0.25] vs [mechanical AVR: 20% to 25%, p=0.99]) between the 2 groups.
Conclusions: The Ross procedure results in greater GLS improvements at peak exercise stress CMR when compared with mechanical AVR. Similarly, the Ross procedure provides normal peak exercise strain values in a larger proportion of patients than mechanical AVR. These findings suggest a physiological explanation for the difference in long-term outcomes observed between these aortic valve replacement options.
Authors
Vincent Chauvette (1), Pierre-Emmanuel Noly (2), Mohamad Mansour (3), Ismail Bouhout (4), Nabil Dib (5), Mathieu Gayda (3), Christine Henri (6), François-Pierre Mongeon (3), Ismail El-Hamamsy (7)
Institutions
(1) Montreal Heart Institute, Montréal, QC, (2) Montreal Heart Institute, Montreal, QC, (3) Montreal Heart Institute, Montreal, Quebec, (4) NewYork-Presbyterian/Columbia University Medical Center, Montréal, QC, (5) Marie Lannelongue, Paris, france, (6) Montreal Heart Institute, Montreal, UT, (7) Mount Sinai Hospital, New York, NY
Methods: A total of 40 patients were enrolled (20 with a previous Ross procedure and 20 with a previous mechanical AVR). Participants were previously screened and matched in a 1:1 ratio based on several preoperative characteristics. All patients underwent exercise stress CMR examination (MR ergometer, Lode, Netherlands). Measurements of LV strain were calculated using a dedicated software (Circle: Cardiovascular Imaging, Calgary, Alberta, Canada).
Results: Baseline characteristics were similar between both groups, with a mean age of 54±11 and 52±11 years in the Ross and mechanical AVR groups, respectively (p=0.60). There were 3 females in the Ross group and 2 in the mechanical AVR group (p=0.99). The time interval between CMR and surgery did not differ between the groups (4±2 years in both cases, p=0.50). LV strain measurements were obtained from all except 1 patient (mechanical AVR) who had suboptimal image quality. Resting LVEF (57±6% vs 59±8%, p=0.22), heart rate (68±13 bpm vs 67±9 bpm, p= 0.98), indexed end-systolic volumes (35±11 mL/m2 vs 34±11 mL/m2, p=0.38), and end-diastolic volumes (80±22 mL/m2 vs 81±14 mL/m2, p=0.43) did not differ between groups. Peak exercise was similar between the Ross and mechanical AVR groups (6.6±1.8 kcal/kg/h vs 6.8±1.7 kcal/kg/h, p=0.77). Global longitudinal strain (GLS) was similar at rest (-14±2% vs -14±2%, p=0.75) but was significantly improved in the Ross group at peak exercise (Figure 1, p= 0.03 for difference in slopes). Furthermore, the proportion of patients reaching normal GLS values at peak exercise was greater in the Ross group (Figure1, from 10% to 65%, p<0.01) when compared with mechanical AVR (from 10% to 35%, p=0.07). Similar findings were observed in analyzing radial long-axis ([Ross: 15% to 80%, p<0.01] vs [mechanical AVR: 30% to 45%, p=0.45]) and radial short-axis strain ([Ross: 60% to 95%, p<0.01] vs [mechanical AVR: 65% to 70%, p=0.13]). Peak exercise circumferential strain was similar between the 2 groups. There was no statistical difference in the number of patients reaching normal circumferential strain values at peak exercise ([Ross: 10% to 25%, p=0.25] vs [mechanical AVR: 20% to 25%, p=0.99]) between the 2 groups.
Conclusions: The Ross procedure results in greater GLS improvements at peak exercise stress CMR when compared with mechanical AVR. Similarly, the Ross procedure provides normal peak exercise strain values in a larger proportion of patients than mechanical AVR. These findings suggest a physiological explanation for the difference in long-term outcomes observed between these aortic valve replacement options.
Authors
Vincent Chauvette (1), Pierre-Emmanuel Noly (2), Mohamad Mansour (3), Ismail Bouhout (4), Nabil Dib (5), Mathieu Gayda (3), Christine Henri (6), François-Pierre Mongeon (3), Ismail El-Hamamsy (7)
Institutions
(1) Montreal Heart Institute, Montréal, QC, (2) Montreal Heart Institute, Montreal, QC, (3) Montreal Heart Institute, Montreal, Quebec, (4) NewYork-Presbyterian/Columbia University Medical Center, Montréal, QC, (5) Marie Lannelongue, Paris, france, (6) Montreal Heart Institute, Montreal, UT, (7) Mount Sinai Hospital, New York, NY
Presentation Duration
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