Right ventricular function after pulmonary autograft replacement of the aortic valve

Background-The pulmonary autograft operation (the Ross procedure involves e xcision of a portion of the right ventricular (RV) outflow tract, prolonged cross-clamp times, and insertion of a pulmonary homograft. There is concer n about the effect of such operations on right ventricular function. Methods and Results-Twenty-five patients undergoing either pulmonary autogr aft or homograft replacement of the aortic valve as part of a prospective r andomized trial had echocardiographic RV long-axis measurements performed b efore surgery and 6 months (range 3 to 12 months) after surgery. Ln all pat ients, systolic excursion (SE) and both shortening and lengthening rates (S R and LR, respectively) were reduced postoperatively (P<0.05) (homografts: SE 1.5+/-0.4 versus 2.3+/-0.6 cm, SR 6.8+/-2.1 versus 9.6+/-3.1 cm/s, LR 6. 0+/-1.8 versus 8.9+/-3.0 cm/s; autografts: SE 1.4+/-0.3 versus 2.2+/-0.4 cm , SR 5.8+/-3.0 versus 8.2+/-3.0 cm/s, LR 5.7+/-1.9 versus 8.5+/-3.7 cm/s). There were no differences between the 2 groups. Eighteen patients who had u ndergone either aortic homograft or pulmonary autograft surgery were studie d between 6 and 35 months after surgery. RV volumes were assessed with the use of MRI in addition to echocardiographic RV long-axis measurements. Glob al volumes were increased to a similar amount in both groups (homografts: e nd-diastolic volume 145+/-34 mL, end-systolic volume 78+/-23 mL; autografts : end-diastolic volume 157+33 mt, end-systolic volume 89+/-25 mt; P=NS), wh ereas stroke volumes were maintained in both groups (homografts 67+/-15 mt, autografts 67+/-16 mt; P=NS). RV SE was depressed in both groups to a simi lar degree to that seen with the previous group (homografts 1.5+-0.3 cm, au tografts 1.4+/-0.2 cm), Conclusions-Aortic valve replacement with either a pulmonary autograft or a n aortic homograft leads to a degree of persistent RV longitudinal dysfunct ion that is not mon pronounced in those undergoing the Ross procedure. The mechanisms and long-term effects of these changes must be further studied.