Is the Ross procedure a riskier operation? Perioperative outcome comparison with mechanical aortic valve replacement in a propensity-matched cohort.

doi:10.1093/icvts/ivw325

Paper

Is the Ross procedure a riskier operation? Perioperative outcome comparison with mechanical aortic valve replacement in a propensity-matched cohort.

Published 2017 · I. Bouhout, P. Noly, Aly Ghoneim

Interactive cardiovascular and thoracic surgery

Q2 SJR score

30

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0

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Abstract

OBJECTIVES The aim of this study was to compare perioperative outcomes in young adults following isolated Ross procedure versus mechanical aortic valve replacement (AVR) in a high-volume centre. METHODS From 2007 to 2015, 337 elective isolated mechanical AVRs and 137 Ross procedures were performed in young adults (<65 years) at our centre. Using a 1:1 propensity score match analysis, 140 patients were included in the study (n = 70 in each group). Perioperative outcomes were defined using STS guidelines. The primary outcome was operative mortality. RESULTS Median age was 52 [14] years and EuroSCORE II was 1.0 [0.4]%. There were no mortalities in the two groups. There were no differences in the incidence of myocardial injury (0% overall) and neurological complications (0.7% overall). Three (4%) reinterventions for bleeding were required in the Ross cohort versus six (9%) in the mechanical AVR cohort (P = 0.49). A significant increase in serum creatinine (>2-fold increase) was more commonly observed after the Ross procedure (11 vs 1%; P = 0.03), but there was no significant difference in the rate of temporary dialysis. Twenty-seven patients (39%) required ≥1 blood product transfusion in the Ross group, whereas 21 patients (31%) did so in the mechanical AVR group (P = 0.47). Median hospital length of stay was similar in both the groups (6 days). CONCLUSIONS There are no differences in mortality or major perioperative outcomes in adults undergoing an isolated Ross procedure or mechanical AVR.

Observational Study

Study Snapshot

Key takeawayThere are no significant differences in mortality or major perioperative outcomes between adults undergoing an isolated Ross procedure or mechanical aortic valve replacement.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

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Is the Ross procedure a riskier operation? Perioperative outcome comparison with mechanical aortic valve replacement in a propensity-matched cohort.

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References

The Ross procedure in young adults: over 20 years of experience in our Institution.

The Ross procedure in young adults is associated with excellent long-term survival, comparable to the general population, with low valve-related events and a risk of reoperation.

Contemporary outcomes of surgery for aortic root aneurysms: A propensity-matched comparison of valve-sparing and composite valve graft replacement.

Aortic root replacement can be performed with low perioperative risk in high-volume centers, with biologic composite valved graft and valve-sparing reconstruction options for those unable to take long-term anticoagulation.

Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults.

In young adults undergoing mechanical aortic valve replacement, survival remains suboptimal compared to an age- and gender-matched general population, with a low but constant hazard of prosthetic valve reintervention.

What is the role of the Ross procedure in today's armamentarium?

The Ross procedure offers long-term benefits in survival, quality of life, hemodynamic characteristics, and freedom from valve-related complications, but remains underused and underappreciated.

Quality of life after aortic valve surgery: replacement versus reconstruction.

In young patients after aortic valve surgery, quality of life is influenced by the type of operation, with aortic valve reconstruction and pulmonary autograft replacement leading to less long-term alteration from normal values.

Citations

Ross Confers More Favorable Left Ventricular Remodeling Compared With Mechanical Aortic Valve Replacement.

The Ross procedure provides more favorable left ventricular remodeling compared to mechanical aortic valve replacement after aortic valve replacement.

Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis

The Ross procedure provides improved long-term outcomes compared to conventional mechanical and bioprosthetic aortic valve replacement options for young and middle-aged patients.

Biological Surgical Options in Young Patients for the Treatment of Severe Aortic Stenosis: Is the Jury Still Out? A Review

Advances in bioprosthetics and data have reduced the cut-off age for using bioprosthetic valves in younger patients with severe aortic stenosis, but the debate on mechanical valves versus biological options remains.

Supporting the Ross procedure: preserving root physiology while mitigating autograft dilatation

The Ross procedure is an effective treatment for nonrepairable aortic valve disease in young adults, preserving root physiology while mitigating autograft dilatation.

The Ross procedure is the optimal solution for young adults with unrepairable aortic valve disease.

The Ross procedure is the optimal solution for young adults with unrepairable aortic valve disease, providing expected survival and improved valvular durability, hemodynamics, and quality of life.

Long-term Clinical and Echocardiographic Outcomes in Young and Middle-aged Adults Undergoing the Ross Procedure.

The Ross procedure provides excellent short-term and long-term outcomes for young and middle-aged adults requiring aortic valve replacement.

Contemporary Review of the Ross Procedure

The Ross procedure offers advantages in long-term survival and quality of life for non-elderly adults, but requires more complex patient selection and management.

Hemodynamic Performance of Dysfunctional Prosthetic Heart Valve with the Concomitant Presence of Subaortic Stenosis: In Silico Study

Doppler parameters can accurately assess the performance of prosthetic heart valves with subaortic stenosis, providing early detection and a proper treatment plan for patients.