Autograft dilation after Ross procedure in children and young adults is mitigated by autograft reinforcement: A retrospective MRI study

Figures

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  Fig. 1. MRI image acquisition Representative 3D-Reconstruction of autograft after free-root implantation (A) and modified subcoronary implantation (D) created using ViewForum (R6.3V1L7 SP1; Philips Healthcare). Measured locations across the pulmonary autograft (B): 1 = aortic annulus; 2 = sinus of Valsalva; 3 = Sino-tublar junction; 4 = ascending aorta. Representative 3D whole heart sequence images of sinus of Valsalva (C) and ascending aorta (F). Sinus of Valsalva diameter in relation to sinus of Valsalva diameter normalized to BSA (z-score) (E). MRI = Magnetic resonance imaging.

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  Fig. 2. Study flow of participants FU = Follow-up time; MRI = Magnetic resonance imaging.

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  Fig. 3. Z-scores of autograft/ aortic dimensions after Ross procedure Z-scores of aortic segments are plotted against patient age at MRI examination (A-D) and time after operation in years (E–H). Aortic valve annulus (A + E); sinus of Valsalva (B + F); ST-junction (C + G); ascending aorta (D + H). MRI = Magnetic resonance imaging.

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  Fig. 4. Impact of patients age at time of the Ross procedure and time after Ross procedure on autograft/ aortic dimensions Z-scores are plotted against elapsed time after operation in years. Predictive margins with 95% CI for z-scores are shown for patient one year of age at time of the Ross procedure in blue and 20 years of age at time of the Ross procedure in red. The cohort data is shown as a scatter plot. Aortic valve annulus (A); sinus of Valsalva (B); ST-junction (C); ascending aorta (D).

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  Fig. 5. The effect of autograft reinforcement on autograft/ aortic dimensions after Ross procedure over time Z-scores are plotted against elapsed time after operation in years. Blue dots and blue line representing cases without autograft reinforcement; Orange dots and green line representing cases with autograft reinforcement. Aortic valve annulus (A); sinus of Valsalva (B); ST-junction (C); ascending aorta (D). MRI = Magnetic resonance imaging.

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  Fig. 6. The effect of autograft reinforcement on autograft/ aortic dimensions and its relation to aortic regurgitation Z-scores are plotted against aortic valve regurgitation fraction (%) for aortic valve annulus (A), sinus of Valsalva (B), ST-junction (C) and ascending aorta (D). Blue dots and blue line representing cases without autograft reinforcement; Orange dots and green line representing cases with autograft reinforcement.

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  Fig. 7. Risk for autograft reintervention Cumulative hazard for autograft reinterventions depended on sinus of Valsalva z-score and time after operation in years. Z-score of 0, 2, 5, and 8 is represented by different color (blue, red, green, yellow).