718 Outcome after heart valve surgery P3522 Preoperative characteristics and late outcomes in patients who develop left ventricular dysfunction following mitral valve surgery for degenerative mitral regurgitation (DMR) O.N. Kislitsina, E. Michel, R.O. Bonow, J.D. Thomas, M. Liu, J. Kruse, A.C. Andrei, P.M. McCarthy. Northwestern University, Cardiac Surgery and Cardiology, Chicago, United States of America Objective: Patients with normal left ventricular (LV) function may develop LV dys- function following mitral valve (MV) surgery for DMR. Our purpose was to deter- mine the preoperative predictors of postoperative LV dysfunction and to document the subsequent degree of LV functional recovery. Methods: From 2004 to 2017, 520 patients with an ejection fraction (EF) >0.60 underwent MV surgery (98% MV repair) for DMR. All patients had preopera- tive (Preop), pre-discharge (PreDc) and follow-up (FUp) (mean= 5.0±3.6 years) echocardiograms (echo). Survival was determined by Kaplan-Meier analysis, and groups were compared using the log-rank test. Multivariate logistic regression and Cox proportional hazards models were used to determine the predictors of early postoperative LV dysfunction and long-term survival, respectively. Results: The median preop LVEF in the entire cohort (n=520) was 0.65 (Q1,Q3 0.60). 449 patients (Group I) maintained normal postoperative function (PreDc LVEF >0.50). 71 patients (13.7%) had PreDc LVEF <0.50 (Group IIa) and 22 of them (4.2%) had LVEF <0.40 (Group IIb) on PreDc echo. Group IIa patients had larger left atrial (LA) dimension (4.5 vs 4.3 cm, p=0.006), increased LV end- systolic dimension (35 vs. 32 cm, p=0.002), increased LV end-diastolic dimension (57 vs. 53, p=0.02), and greater MR volume (89,0 vs. 65.5 ml, p<0.06) than Group I patients and more Group IIa patients were discharged on antiarrhythmics and ACE inhibitors. Group IIb patients had larger MR volumes than Group I patients (98.0 vs. 66.0 ml, respectively, p=0.05) and larger Effective Regurgitant Orifices (0.8 vs 0.5 cm 2 , respectively, p=0.017). Mean systolic pulmonary artery pressure (mm Hg) in Group I patients decreased from 32 to 26 (p<0.036) following mitral repair, but it did not change in Group IIb patients (Preop=33, PreDc=33), indicat- ing fixed pulmonary hypertension. Operative mortality was 5% (1/22) in Group IIb and <1% (1/449) in Group I (p=0.001). More Group IIb patients developed postop pneumonia, and renal failure and more were discharged on antiarrhythmics and aspirin. LVEF returned to normal (>0.55) in all Group I and Group II patients as determined by FUp echo at the last outpatient visit (See Charts). Five-year sur- vival did not differ between Group I and Groups IIa/IIb and was 96.0% and 92.6%, respectively. Conclusions: A decrease in LV function is not uncommon following mitral valve surgery for DMR and typically occurs in patients with preoperative LA and LV dila- tion and elevated right-side pressures, and the postoperative dysfunction is worse after the development of fixed pulmonary hypertension. Postoperative complica- tions are more prevalent but 30-day mortality is unaffected by the postoperative dysfunction and LV function returns to normal levels with time. These findings suggest that mitral valve repair for DMR should be performed before the LV be- comes dilated and certainly before changes occur in the pulmonary vasculature and right heart. P3523 Outcomes after surgical repair of tetralogy of Fallot with absent pulmonary valve: results from a national registry D.M. Dorobantu 1 , D. Taliotis 2 , A.C. Visan 3 , R. Tulloh 2 , S.C. Stoica 2 . 1 Institute of Cardiovascular Diseases Prof. C.C. Iliescu, Bucharest, Romania; 2 Bristol Royal Hospital for Children, Bristol, United Kingdom; 3 University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom Background: Tetralogy of Fallot with absent pulmonary valve syndrome (ToF- APVS) is a rare variant, associated with severe pulmonary valve regurgitation and aneurysmal dilation of the pulmonary arteries. Reported outcomes after surgical corrections are limited to single center, older series. Purpose: We used data from a national registry to evaluate short and long term outcomes after surgical repair of ToF-APVS, to serve for counselling and planning. Methods: All children undergoing ToF-APVS repair in the UK between 2002 and 2013 were included. Survival and freedom from reintervention were estimated us- ing the Kaplan Meier method. The hazard ratios (HR) are from univariable analy- sis using the Weibull regression model. Results: A total of 99 children were included: 54% male, 10% with 22q11 dele- tion, median age of 212 days (1 day to 13 years). The following pre-repair pro- cedures were performed: 3 Blalock-Taussig shunts, 3 MAPCA occlusions and 2 patent arterial duct closures. Mortality at 30 days was 3.3%, slightly higher for neonates (6.8% versus 2.7% in the rest, p=0.4). The figure shows outcomes at 10 years. One patient underwent MAPCA occlusion during follow-up. Neonates had lower survival (HR 6.2, p=0.02), freedom from PVR (HR 4.5, p=0.01), free- dom from pulmonary arterioplasty (HR 6.6, p=0.001) and overall freedom from any reintervention (HR 5.3, p<0.001). Low weight at repair was associated with worse freedom from PVR (p=0.02) and from pulmonary arterioplasty (p=0.009), while the presence of 22q11 deletion was associated with lower freedom from PVR (HR 4, p=0.02). Outcomes after ToF-APVS repair Conclusions: Correction of ToF-APVS can be achieved with low mortality, al- though higher when it is needed in the neonatal period. The need for right ven- tricular outflow tract and pulmonary artery reinterventions, is an expected issue in the long term for the majority of patients, but more importantly after neonatal correction. P3524 Outcome after ross procedure in adult patients: a systematic review, meta-analysis and microsimulation S. Sibilio 1 , A. Koziarz 2 , G. McClure 3 , A. Alsagheir 4 , H. Alraddadi 5 , A. Lengyel 6 , S. Reza 7 , K. Um 3 , P. Mendoza 6 , S. Mclsaac 4 , D. Paparella 1 , I. El-Hamamsy 8 , D. Parry 5 , E. Belley-Cote 4 , R. Whitlock 4 . 1 University of Bari, Hospital Policlinico, Bari, Italy; 2 McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Canada; 3 McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Canada; 4 Population Health Research Institute, Cardiac surgery, Hamilton, Canada; 5 McMaster University, Department of surgery, Hamilton, Canada; 6 McMaster University, Undergraduate Faculty of Health Sciences, Hamilton, Canada; 7 Waterloo University, Undergraduate Faculty of Health Sciences, Waterloo, Canada; 8 Montreal Heart Institute, Department of surgery, Montreal, Canada. On behalf of MINION-CIA Background: Contemporary data suggest that aortic valve replacement with bi- ological and mechanical prostheses reduces life expectancy in non-elderly adults compared to age and gender matched controls. The Ross procedure may yield outcomes more similar to an age- and gender- matched general population. Purpose: We conducted a systematic review and meta-analysis to estimate the risk of adverse events and event-free life expectancy after the Ross procedure in adult patients. Methods: We searched MEDLINE, EMBASE, and Cochrane CENTRAL from in- ception to June 2017 for reports evaluating the Ross procedure in patients ≥16 years of age. We performed screening, full-text assessment, risk-of-bias evalua- tion and data collection independently and in duplicate. We pooled data using a random effects model for the outcome-based analysis. We used a microsimula- tion model to evaluate age- and gender-specific life expectancy. Results: We pooled data from 66 articles, totalling 21348 participants in 20 coun- tries. We judged thirty-seven papers to be at low risk of bias, 21 at high risk and 8 Downloaded from https://academic.oup.com/eurheartj/article/39/suppl_1/ehy563.P3524/5083643 by guest on 29 January 2023