Autograft remodeling after the Ross procedure by cardiovascular magnetic resonance imaging: aortic stenosis versus insufficiency

ABSTRACT Background Studies suggest that patients undergoing the Ross procedure for aortic insufficiency (AI) are at greater risk of autograft dilatation than those with aortic stenosis (AS). Using a tailored Ross technique to mitigate autograft dilatation in patients with aortic insufficiency (AI), we aimed to compare the biomechanical and morphological remodelling of the autograft at one year between AI and AS patients. Methods 210 patients underwent a Ross procedure (2011-2016). Of those, 86 patients (mean age 43±13 years, 32% female) completed pre- and postoperative cardiovascular magnetic resonance (CMR) imaging. 71 studies were suitable for analysis: 41 AS patients and 30 AI patients. Nine healthy adults were used as controls. Autograft root dimensions, individual sinus volumes and distensibility were measured using CMR. Results At 1 year, there was no difference in autograft root dimensions between AS (mean annulus 25.1±3.1mm and sinus diameters 35±4.1mm) and AI patients (26.6±3mm and 37.1±3.5mm; p=0.12 and 0.06 respectively). Relative sinus of Valsalva volumes were symmetrical in the AS (right 34.8±4%, left 33.7±3.5, non-coronary 31.4±3.2%) and AI groups (34.8±3.9%, 33.8±2.8%, 31.3±3.7%, p=0.85, 0.92 and 0.82), and similar to healthy adults. Aortic root distensibility was reduced in both groups compared to healthy adults (p=0.003), but was similar between AS (3.12±1.58*10-3mmHg-1) and AI (3.04±1.15*10-3mmHg-1; p=0.9). Conclusion Using a tailored technique, there were no differences in the morphological or biomechanical remodeling of the autograft root one year after the Ross procedure between AS and AI patients. However, autograft roots are stiffer than native aortic roots.