Pregnancy after the ross procedure: imaging pathway and clinical outcomes

Abstract Background Few data on the impact of pregnancy-related autograft and homograft function in patients who have undergone the Ross procedure exist [1]. Purpose This study reports on maternal and fetal outcomes, as well as the imaging pathways, in women with a prior Ross procedure. Methods We conducted a retrospective analysis of women who underwent the Ross procedure and later became pregnant. Echocardiographic Doppler findings on autograft and homograft function, the need for reintervention, and obstetric outcomes were collected. Results 16 women with prior Ross procedures experienced a total of 56 pregnancies (Table 1). The mean age at the time of Ross procedure was 17.7 ± 6.8 years, and the mean follow-up duration was 22.3 ± 8.2 years, with the longest follow-up reaching 32 years. At the time of the procedure, patients were between 8 and 32 years of age (mean 18.1 ± 7.0 years). The average time from Ross procedure to the first pregnancy was 10.9 ± 5.9 years (range 1 to 24 years), and the average age at first pregnancy was 28.8 ± 6.7 years (range 16 to 40 years). Patients had an average of 3.4 ± 1.9 pregnancies. The deliveries were vaginal (79%), while cesarean sections in 21%. Indications for the Ross procedure were: rheumatic heart disease (63%); bicuspid aortic valve (31%); and familial hypercholesterolemia (6%) [2]. The most common underlying pathology was aortic stenosis (56%), followed by aortic regurgitation (38%). There were no maternal deaths and no cases of heart failure during pregnancy. Five patients (31%) required a reintervention after an average of 10.8 ± 6.2 years, and two of them underwent a second intervention approximately 12 years postoperatively. Interventions included autograft or pulmonary valve replacement and percutaneous pulmonary valve implantation. Cardiac imaging showed no significant change in homograft function after the first pregnancy or worsening of the autograft function (Figure 2) [1]. Obstetric and neonatal complications included 1 case of placenta previa, 3 spontaneous abortions, and 2 neonatal hypoxic brain injuries. Patient demographics, delivery outcomes, and cardiac events are shown in (Table 1). Conclusion This cohort represents the largest and longest follow-up of pregnancies in women with a prior Ross procedure. Our findings suggest that pregnancy post-Ross procedure is well tolerated with no change in autograft function and only mild progression in homograft dysfunction. These results offer valuable data for surgical decision-making in young women with aortic pathology and risk stratification in pregnant women post-Ross procedure. Transthoracic echocardiography, as the imaging modality of choice, is a reliable tool for functional assessment; it is recommended at the onset of pregnancy, at term, and six months postpartum [1].Table 1 Figure 2