The Impact of Tricuspid Regurgitation Following the Ross Procedure: A North American Multicenter Study

Structured Abstract Objective Tricuspid regurgitation is a known complication following the Ross procedure in adults. Risk factors and overall clinical impact are unknown. Methods Patients that underwent a Ross procedure at a participating site in the North American Ross Consortium were stratified based on presence of post-operative ≥ moderate TR within the first 30 days post-operatively (1994-2024). Data was analyzed for differences in peri-operative and medium-term outcomes. Results Final cohort size was 608 patients, with 57 (9.4%) developing ≥ moderate TR post-operatively. Patients in the TR group were more likely to be female (54.4% vs. 27.7%, p<0.001), have a history of endocarditis (15.8% vs. 5.2%, p=0.0077), and have had a previous median sternotomy (19.3% vs. 9.1%, p=0.0145). TR patients had longer cardiopulmonary bypass times (227 mins vs. 212 mins, p=0.0084) as well as hospital length of stay (6.0 days vs. 5.0 days, p=0.0018). Rate of post-operative pacemaker implantation was higher in the TR group (8.8% vs. 2.9%, p=0.0395). Early and mid-term mortality did not differ between groups (p=0.4037). There was no difference in valve reintervention rate out to 5 years (p=0.66) and no patients in the TR group required tricuspid valve reintervention. TR resolved to < moderate in 79% of the TR group by 1-year post-operatively. Conclusions Tricuspid regurgitation develops in nearly 10% of patients following the Ross procedure. TR results in longer hospital LOS and higher rate of PPM implantation. There is no difference in mid-term valve reintervention rate or mortality. Most TR resolves within the first post-operative year, supporting conservative therapy.