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Background The inverse association between estimated glomerular filtration rate (eGFR) and cardiovascular risk is well recognised but not fully explained. Kidney donation is known to reduce renal function by approximately 30% and allows the prospective study of the cardiovascular effects of a reduced eGFR in healthy subjects without confounding comorbidities. We report five year results in a group of kidney donors and healthy controls who underwent extensive cardiovascular assessment. Methods A 5 year longitudinal, parallel group, blinded end-point study of living kidney donors (n=50) and healthy controls (n=45). Participants underwent office and 24-hr ambulatory blood pressure measures, multi-parametric cardiac magnetic resonance imaging (MRI) (3 Tesla), measurement of arterial stiffness (SphygmoCor), carotid intima-media thickness and blood and urine analysis at baseline, one year and 5 years from donation. Results The eGFR in donors at baseline was 95 ± 15ml/min/1.73m2, 65 ± 13ml/min/1.73m2 at one year and 67 ± 14ml/min/1.73m2 at 5 years. Left ventricular (LV) mass was 112g at baseline in both groups and was not different at 5 years (113 ± 31 vs. 115 ± 30, p=0.707). There was also no difference in LV volumes, LV geometry, LV function, T1 times or extracellular volume (ECV) on MRI. Office and ambulatory blood pressures did not differ from controls at any time point. Pulse wave velocity was higher in donors at one year but not significantly different by 5 years. At 5 years, there was no significant differences in the prevalence of a detectable troponin or mean plasma NT pro-BNP. Conclusion The stable reduction in eGFR to levels of 60-70 ml/min/1.73m2 after live kidney donation does not lead to deleterious changes in cardiovascular structure and function or biomarkers of cardiovascular disease at 5 years. Factors associated with kidney disease other than an isolated fall in eGFR are likely to explain the increased cardiovascular risk in patients with chronic kidney disease. Figure A and B: Longitudinal change in LV mass and PWV before and after donation in donors and controls. Black solid lines are means with confidence intervals for donors and dashed lines represent controls. Black squares indicate study visits. A; Left ventricular mass (g) and B; Adjusted pulse wave velocity (m/s) (adjusted for mean arterial pressure and heart rate). Conflict of Interest None

Background The neo-aorta produced by the pulmonary autograft following the Ross procedure has excellent long-term outcomes, with an increasing number of women now undergoing pregnancy following Ross. Cardiac Magnetic Resonance (CMR) has been used to evaluate the risk of progression of neo-aortic dilatation and dissection that may arise as a result of the additional cardiovascular risks posed during pregnancy. Although there have been reported cases of dilatation and dissection, there is little research. Aims To evaluate the extent of neo-aortic dilatation, and associated aortic regurgitation, during pregnancy following the Ross procedure. Methods A retrospective cohort of women were identified who had undergone a Ross procedure after 1985, who in January 2019 were aged >16, in an adult congenital cardiology and joint cardiac-obstetric centre. CMR data was used to evaluate neo-aortic root dimensions and aortic regurgitation extent pre-, during and post- pregnancy. A control group of case-matched patients who had undergone the Ross procedure, but not pregnancy, was used for comparison. Results In all, 8 women carried a total of 15 pregnancies to term. In only one pregnancy did the mother experience serious cardiac decompensation, necessitating early delivery and associated with subaortic stenosis, mild aortic root dilatation and increasing aortic regurgitation. Four women (50%) experienced an element of aortic root dilatation during pregnancy, with an average increase between them of 0.525 cm (range +0.4 to+0.7). In no case did this lead to progressive dilatation or dissection. When compared to the control group, pregnancy was found to carry an increased risk of neo-aortic dilatation (Mean aortic root change for group:+0.26 cm (SD 0.30) pregnancy vs. +0.16 cm (SD 0.27) control). There was a high rate of initial mild aortic regurgitation in both groups. In three women their extent of regurgitation increased post-pregnancy, correlated with increased parity and aortic dilatation. In the control group only two women experienced increased regurgitation, only one of which was associated with neo-aortic dilatation. Conclusions Pregnancy appears generally well tolerated by women following the Ross Procedure, although there is an increased risk of neo-aortic dilatation and corresponding increase in aortic regurgitation compared to the control group.