Ismail El-Hamamsy, MD, PhD, Nana Toyoda, MD, PhD, Shinobu Itagaki, MD, MSc, Paul Stelzer, MD, Robin Varghese, MD, Elbert E. Williams, MD, Natalia Egorova, PhD, David H. Adams, MD
Background: There has recently been renewed interest in the Ross procedure in adults.
Objectives: The goal of this study was to compare long-term outcomes after the Ross procedure vs biological and mechanical aortic valve replacement (AVR) in adults (aged 18-50 years) undergoing aortic valve surgery.
Methods: Mandatory California and New York databases were queried between 1997 and 2014. Exclusion criteria included: ≥1 concomitant procedure, reoperations, infective endocarditis, intravenous drug use, hemodialysis, and out-of-state residency. Propensity matching (1:1:1) was used, resulting in 434 patients per group. The primary endpoint was all-cause mortality. Secondary endpoints were stroke, major bleeding, reoperation, and endocarditis. Median follow-up was 12.5 years (IQR: 9.3-15.7 years).
Results: At 15 years, actuarial survival after the Ross procedure was 93.1% (95% CI: 89.1%-95.7%), similar to that of the age-, sex-, and race-matched U.S. general population. It was significantly lower after biological AVR (HR: 0.42; 95% CI: 0.23-0.075; P = 0.003) and mechanical AVR (HR: 0.45; 95% CI: 0.26-0.79; P = 0.006). At 15 years, the Ross procedure was associated with a lower cumulative risk of reintervention (P = 0.008) and endocarditis (P = 0.01) than biological AVR. In contrast, at 15 years, the Ross procedure was associated with a higher cumulative incidence of reoperation (P < 0.001) but lower risks of stroke (P = 0.03) and major bleeding (P = 0.016) than mechanical AVR. Thirty-day mortality after valve-related complications was lowest after a reintervention.
Conclusions: In young adults, the Ross procedure is associated with better long-term survival and freedom from valve-related complications compared with prosthetic AVR. This confirms the notion that a living valve substitute in the aortic position translates into improved clinically relevant outcomes.
Keywords: Ross procedure; aortic valve replacement; bioprostheses; mechanical valves.
- David H. Adams, MD, Dimosthenis Pandis, MD, Shaf Keshavjee, MD
Propensity-Matched Comparison of the Ross Procedure and Prosthetic Aortic Valve Replacement in AdultsIsmail El-Hamamsy, MD, PhD, Nana Toyoda, MD, PhD, Shinobu Itagaki, MD, MSc, Paul Stelzer, MD, Robin Varghese, MD, Elbert E. Williams, MD, Natalia Egorova, PhD, David H. Adams, MD
- Amine Mazine, Nitish K Dhingra, Michael W A Chu, Ismail El-Hamamsy, Mark D Peterson
- Dimosthenis Pandis, MD, MSc, Anelechi C. Anyanwu, MD, FRCS, David H. Adams, MD, FACC