Perioperative and Long-Term Outcomes of Ross versus Mechanical Aortic Valve Replacement

Background The ideal aortic valve replacement strategy in young- and middle-aged adults remains up for debate. Clinical practice guidelines recommend mechanical prostheses for most patients less than 50 years of age undergoing aortic valve replacement. However, risks of major hemorrhage and thromboembolism associated with long-term anticoagulation may make the pulmonary autograft technique, or Ross procedure, a preferred approach in select patients. Methods Data were retrospectively collected for patients 18 to 50 years of age who underwent either the Ross procedure or mechanical aortic valve replacement (mAVR) between January 2000 and December 2016 at a single institution. Propensity score matching was performed and yielded 32 well-matched pairs from a total of 216 eligible patients. Results Demographic and preoperative characteristics were similar between the two groups. Median follow-up was 7.3 and 6.9 years for Ross and mAVR, respectively. There were no early mortalities in either group and no statistically significant differences were observed with respect to perioperative outcomes or complications. Major hemorrhage and stroke events were significantly more frequent in the mAVR population ( p < 0.01). Overall survival ( p = 0.93), freedom from reintervention and valve dysfunction free survival ( p = 0.91) were equivalent. Conclusions In this mid-term propensity score-matched analysis, the Ross procedure offers similar perioperative outcomes, freedom from reintervention or valve dysfunction as well as overall survival compared to traditional mAVR but without the morbidity associated with long-term anticoagulation. At specialized centers with sufficient expertise, the Ross procedure should be strongly considered in select patients requiring aortic valve replacement.

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Ross Procedure: How to Do It and How to Teach It

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119852324 ◽

2019 ◽

Vol 10 (5) ◽

pp. 624-627

Author(s):

Jeremy L. Herrmann ◽

Amanda R. Stram ◽

John W. Brown

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Prosthetic Valve ◽

Pulmonary Valve ◽

Prosthetic Graft ◽

Ascending Aorta ◽

Ross Procedure

Prosthesis choice for aortic valve replacement (AVR) in children is frequently compromised by unavailability of prostheses in very small sizes, the lack of prosthetic valve growth, and risks associated with long-term anticoagulation. The Ross procedure with pulmonary valve autograft offers several advantages for pediatric and adult patients. We describe our current Ross AVR technique including replacement of the ascending aorta with a prosthetic graft. The procedure shown in the video involves an adult-sized male with a bicuspid aortic valve, mixed aortic stenosis and insufficiency, and a dilated ascending aorta.

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Prosthesis-patient mismatch after surgical aortic valve replacement in patients with aortic stenosis

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa085 ◽

2020 ◽

Vol 31 (2) ◽

pp. 152-157

Author(s):

Hee Jung Kim ◽

Ho Jin Kim ◽

Joon Bum Kim ◽

Sung-Ho Jung ◽

Suk Jung Choo ◽

...

Keyword(s):

Risk Factor ◽

Aortic Valve ◽

Propensity Score ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Propensity Score Matching ◽

Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Risk Of Death

Abstract OBJECTIVES The issue of prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) has been a controversial topic. We sought to evaluate the long-term clinical impacts of PPM in patients undergoing SAVR in an updated, homogeneous cohort. METHODS Using the prospective institutional database, we identified 895 adult patients (median age 66, interquartile range 58–72; 45.6% women) who underwent isolated SAVR from January 2000 to March 2016. Those with pure aortic insufficiency and concomitant other cardiac operations were excluded from this study cohort. The presence of a significant PPM was defined as an indexed effective orifice area 0.85 cm2/m2 or less. The outcome of interest was all-cause deaths. Propensity score matching was performed for adjusting bias. RESULTS Significant PPM was present in 247 patients (27.6%). During the follow-up period (mean 71.2 ± 51.04 months), 134 patients (15%) died. Survival rates at 10 and 15 years were 78.3% vs 83.8% and 71.3% vs 57.6% in the PPM and non-PPM groups (P = 0.972). Risk factor analysis indicated that developing PPM was not associated with a risk of death. After propensity score matching (1:1), developing PPM was not a risk factor for long-term death as well (P = 0.584). CONCLUSIONS Significant PPM was common after SAVR in patients with aortic stenosis. However, there was no significant difference in survival rate between those with and without PPM.

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LONG-TERM OUTCOMES OF THE ROSS PROCEDURE VERSUS MECHANICAL AORTIC VALVE REPLACEMENT: A PROPENSITY-MATCHED COHORT STUDY

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2016.07.377 ◽

2016 ◽

Vol 32 (10) ◽

pp. S234-S235

Author(s):

A. Mazine ◽

T.E. David ◽

V. Rao ◽

E.J. Hickey ◽

S. Christie ◽

...

Keyword(s):

Cohort Study ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Matched Cohort ◽

Ross Procedure ◽

Long Term Outcomes ◽

Matched Cohort Study ◽

Mechanical Aortic Valve

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Mechanical valves versus the Ross procedure for aortic valve replacement in children: Propensity-adjusted comparison of long-term outcomes

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2008.10.010 ◽

2009 ◽

Vol 137 (2) ◽

pp. 362-370.e9 ◽

Cited By ~ 53

Author(s):

Bahaaldin Alsoufi ◽

Zohair Al-Halees ◽

Cedric Manlhiot ◽

Brian W. McCrindle ◽

Mamdouh Al-Ahmadi ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Ross Procedure ◽

Long Term Outcomes ◽

Mechanical Valves

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Surgical versus transcatheter aortic valve replacement in low‐risk patients: A long‐term propensity score‐matched analysis

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.29948 ◽

2021 ◽

Author(s):

Catarina Brízido ◽

Márcio Madeira ◽

João Brito ◽

Sérgio Madeira ◽

Rui Campante Teles ◽

...

Keyword(s):

Aortic Valve ◽

Propensity Score ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Low Risk ◽

Transcatheter Aortic Valve ◽

Risk Patients

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Aortic valve replacement in pediatric patients: 30 years single center experience

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01636-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Johanna Schlein ◽

Paul Simon ◽

Gregor Wollenek ◽

Eva Base ◽

Günther Laufer ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Interdisciplinary Approach ◽

Ross Procedure ◽

Long Term Outcomes ◽

Bleeding Events ◽

Time Of Surgery ◽

Single Center Experience

Abstract Background The choice of aortic valve replacement needs to be decided in an interdisciplinary approach and together with the patients and their families regarding the need for re-operation and risks accompanying anticoagulation. We report long-term outcomes after different AVR options. Methods A chart review of patients aged < 18 years at time of surgery, who had undergone AVR from May 1985 until April 2020 was conducted. Contraindications for Ross procedure, which is performed since 1991 at the center were reviewed in the observed non-Ross AVR cohort. The study endpoints were compared between the mechanical AVR and the biological AVR cohort. Results From May 1985 to April 2020 fifty-five patients received sixty AVRs: 33 mechanical AVRs and 27 biological AVRs. In over half of the fifty-three AVRs performed after 1991 (58.5%; 31/53) a contraindication for Ross procedure was present. Early mortality was 5% (3/60). All early deaths occurred in patients aged < 1 year at time of surgery. Two late deaths occurred and survival was 94.5% ± 3.1% at 10 years and 86.4% ± 6.2% at 30 years. Freedom from aortic valve re-operation was higher (p < 0.001) in the mechanical AVR than in the biological AVR cohort with 95.2% ± 4.6% and 33.6% ± 13.4% freedom from re-operation at 10 years respectively. Conclusions Re-operation was less frequent in the mechanical AVR cohort than in the biological AVR cohort. For mechanical AVR, the risk for thromboembolic and bleeding events was considerable with a composite linearized event rate per valve-year of 3.2%.

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