Ventricular interactions and electromechanical dyssynchrony after Ross and Ross-Konno operations

Abstract

Objectives: Ross and Ross-Konno operations are associated with the inherent risk of residual ventricular septal dysfunction and injury to the conduction system. However, comprehensive biventricular functional outcomes on magnetic resonance imaging after Ross and Ross-Konno procedures are unknown. The purpose of this study was to evaluate and compare the degree of electrical and mechanical dyssynchrony using cardiac magnetic resonance imaging in patients late after Ross and Ross-Konno operations.

Methods: Patients following Ross operation (n = 16), Ross-Konno operation (n = 13), and healthy controls (n = 12) underwent cardiac magnetic resonance imaging strain deformation analysis to quantify left ventricular (LV) intraventricular dyssynchrony and right ventricular (RV)-LV interventricular dyssynchrony. Mechanical dyssynchrony indices were correlated with the degree of electrical dyssynchrony as assessed by QRS duration, as well as with magnetic resonance imaging-derived biventricular and autograft regurgitation parameters.

Results: Patients in the Ross and Ross-Konno groups had reduced LV global longitudinal strain when compared with controls (both P values < .01). Both Ross (P < .05) and Ross-Konno (P < .01) groups demonstrated increased RV-LV interventricular dyssynchrony compared with controls. Patients in the Ross-Konno group also had increased septal LV intraventricular dyssynchrony when compared with control and Ross groups (both P values < .01). The global LV intramechanical dyssynchrony strongly correlated with QRS duration (R = 0.716; P < .001). There was no association between mechanical dyssynchrony and aortic regurgitation fraction.

Conclusions: Long-term follow-up of patients who underwent Ross and Ross-Konno operations demonstrates reduced LV global longitudinal strain suggestive of chronically increased afterload independent of autograft function. Additionally, Ross-Konno operation is associated with impaired LV intraventricular mechanics and electrical dyssynchrony.

Keywords: Ross operation; Ross-Konno operation; electromechanical dyssynchrony.