Impact of Discharge Antihypertensive Therapy on Left-Sided Reinterventions Following the Pediatric Ross Procedure

BackgroundPost-Ross procedure antihypertensive treatment strategies differ substantially, with no clear consensus and limited evidence to inform decision-making. We evaluated the association between discharge oral antihypertensive medications and post-discharge outcomes in pediatric Ross procedure patients. MethodsChildren (<18 years) undergoing the Ross procedure in the Pediatric Health Information Systems database (2004-2024) were included. Patients were divided into two groups based on discharge antihypertensives defined as the receipt of oral antihypertensive medication during the final two days of hospitalization: Anti-hypertensive (Anti-HTN) versus no-Anti-HTN groups. Primary outcomes were composite of left-sided (neo aortic valve/root/arch) reintervention or mortality at up to five years post-procedure. Trends in oral-antihypertensive therapy use post-Ross were examined. Results2,097 children were included, of which 1,234 (59%) were discharged with an oral anti-hypertensive regimen. Of these, 253 (21%) were discharged on >1 oral anti-hypertensive drug class. Anti-HTN patients had lower rates of the composite of left-sided interventions or mortality at one (2.8% vs 6.1%), three (6.3% vs 9.8%) and five years (8.9% vs 13.9%), log-rank=0.0025). On stratification by age categories, statistically significant results were only observed in age category 1-12 years (log-rank=0.0127). Lowest reintervention/mortality rates were observed in patients receiving beta-blockers (log-rank=0.0112). Between 2006 and 2022, there was an increase in discharge prescription rates of beta-blockers and >1 anti-hypertensive drug class. ConclusionsFollowing pediatric Ross procedure, discharge antihypertensive therapy was associated with a reduced composite risk particularly in the 1-12 year age group. These findings support prospective studies to define optimal antihypertensive strategies in Ross procedure patients.