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Improved Survival After the Ross Procedure Compared With Mechanical Aortic Valve Replacement
Edward Buratto1, William Y Shi1, Rochelle Wynne2
1University of Melbourne, Melbourne, Victoria, Australia.
Journal of the American College of Cardiology
|March 24, 2018
Summary
The Ross procedure demonstrates superior long-term survival compared to mechanical aortic valve replacement (AVR) in younger adults. This finding supports considering the Ross procedure in experienced centers for patients with significant life expectancy.
Area of Science:
- Cardiac Surgery
- Thoracic Surgery
- Cardiovascular Research
Background:
- The comparative long-term survival of the Ross procedure versus mechanical aortic valve replacement (AVR) remains unclear.
- Mechanical AVR is a common treatment for aortic valve disease, but concerns exist regarding long-term outcomes and valve durability.
Purpose of the Study:
- To evaluate and compare the long-term survival rates between the Ross procedure and mechanical AVR.
- To assess the safety and efficacy of the Ross procedure in a contemporary cohort.
Main Methods:
- A retrospective comparison of 392 Ross procedures and 1,928 mechanical AVRs performed between 1992 and 2016.
- Inclusion criteria focused on patients aged 18-65 years.
- Propensity-score matching was utilized for risk adjustment to ensure comparable groups.
Main Results:
- Ross procedure patients were younger with fewer cardiovascular risk factors.
- Thirty-day mortality was similar between the two groups (0.3% vs. 0.8%).
- The Ross procedure showed significantly superior unadjusted (95% vs. 68%) and propensity-score matched (94% vs. 84%) 20-year survival rates, with a reduced risk of late mortality (HR 0.34).
Conclusions:
- The Ross procedure is associated with better long-term survival compared to mechanical AVR in younger patients.
- The Ross procedure should be considered in specialized centers for younger patients with a long life expectancy.
- Further research may explore long-term quality of life outcomes.
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