Improved outcomes following the ross procedure compared with bioprosthetic aortic valve replacement

BackgroundThe ideal aortic valve substitute for young and middle-aged adults remains elusive. Bioprosthetic aortic valve replacement (AVR) is increasingly being performed in this patient population. This study sought to compare the long-term outcomes of patients undergoing the Ross procedure and those receiving bioprosthetic AVR.Methods and ResultsConsecutive patients aged 16-60 who underwent a Ross procedure or surgical bioprosthetic AVR at a single institution between 1990 and 2014 were identified. Patients with acute aortic dissection, active endocarditis, end-stage renal disease, or requiring emergency surgery were excluded. Patients who received an aortic homograft or a Toronto SPV stentless bioprosthesis were also excluded from the bioprosthetic AVR group. Propensity score matching was used to account for differences in baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes included valve reintervention, valve deterioration, endocarditis, thromboembolic events, and permanent pacemaker implantation. A total of 789 patients met inclusion criteria (Ross procedure n=233; bioprosthetic AVR n=556). Propensity score matching yielded 108 pairs of patients. Median age was 41 years (interquartile range: 34 – 47), and 31% of patients were female. Baseline characteristics were similar between the matched groups. There was no operative mortality in either group. There were no differences in rates of early complications. Mean follow-up was 14.5 ± 7.2 years. All-cause mortality was lower following the Ross procedure (hazard ratio [HR] 0.35, 95% confidence interval [CI] [0.14–0.90]; p=0.028) (Figure 1). Using death as a competing risk, the Ross procedure was associated with lower rates of reintervention (HR 0.21, 95% CI [0.10–0.41]; p< 0.001), valve deterioration (HR 0.25, 95% CI [0.14–0.45]; p< 0.001), thromboembolic events (HR 0.15, 95% CI [0.05–0.50]; p=0.002), and permanent pacemaker implantation (HR 0.22, 95% CI [0.07–0.64]; p=0.006) (Table 1).ConclusionView Large Image Figure ViewerDownload Hi-res image Download (PPT) BackgroundThe ideal aortic valve substitute for young and middle-aged adults remains elusive. Bioprosthetic aortic valve replacement (AVR) is increasingly being performed in this patient population. This study sought to compare the long-term outcomes of patients undergoing the Ross procedure and those receiving bioprosthetic AVR. The ideal aortic valve substitute for young and middle-aged adults remains elusive. Bioprosthetic aortic valve replacement (AVR) is increasingly being performed in this patient population. This study sought to compare the long-term outcomes of patients undergoing the Ross procedure and those receiving bioprosthetic AVR. Methods and ResultsConsecutive patients aged 16-60 who underwent a Ross procedure or surgical bioprosthetic AVR at a single institution between 1990 and 2014 were identified. Patients with acute aortic dissection, active endocarditis, end-stage renal disease, or requiring emergency surgery were excluded. Patients who received an aortic homograft or a Toronto SPV stentless bioprosthesis were also excluded from the bioprosthetic AVR group. Propensity score matching was used to account for differences in baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes included valve reintervention, valve deterioration, endocarditis, thromboembolic events, and permanent pacemaker implantation. A total of 789 patients met inclusion criteria (Ross procedure n=233; bioprosthetic AVR n=556). Propensity score matching yielded 108 pairs of patients. Median age was 41 years (interquartile range: 34 – 47), and 31% of patients were female. Baseline characteristics were similar between the matched groups. There was no operative mortality in either group. There were no differences in rates of early complications. Mean follow-up was 14.5 ± 7.2 years. All-cause mortality was lower following the Ross procedure (hazard ratio [HR] 0.35, 95% confidence interval [CI] [0.14–0.90]; p=0.028) (Figure 1). Using death as a competing risk, the Ross procedure was associated with lower rates of reintervention (HR 0.21, 95% CI [0.10–0.41]; p< 0.001), valve deterioration (HR 0.25, 95% CI [0.14–0.45]; p< 0.001), thromboembolic events (HR 0.15, 95% CI [0.05–0.50]; p=0.002), and permanent pacemaker implantation (HR 0.22, 95% CI [0.07–0.64]; p=0.006) (Table 1). Consecutive patients aged 16-60 who underwent a Ross procedure or surgical bioprosthetic AVR at a single institution between 1990 and 2014 were identified. Patients with acute aortic dissection, active endocarditis, end-stage renal disease, or requiring emergency surgery were excluded. Patients who received an aortic homograft or a Toronto SPV stentless bioprosthesis were also excluded from the bioprosthetic AVR group. Propensity score matching was used to account for differences in baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes included valve reintervention, valve deterioration, endocarditis, thromboembolic events, and permanent pacemaker implantation. A total of 789 patients met inclusion criteria (Ross procedure n=233; bioprosthetic AVR n=556). Propensity score matching yielded 108 pairs of patients. Median age was 41 years (interquartile range: 34 – 47), and 31% of patients were female. Baseline characteristics were similar between the matched groups. There was no operative mortality in either group. There were no differences in rates of early complications. Mean follow-up was 14.5 ± 7.2 years. All-cause mortality was lower following the Ross procedure (hazard ratio [HR] 0.35, 95% confidence interval [CI] [0.14–0.90]; p=0.028) (Figure 1). Using death as a competing risk, the Ross procedure was associated with lower rates of reintervention (HR 0.21, 95% CI [0.10–0.41]; p< 0.001), valve deterioration (HR 0.25, 95% CI [0.14–0.45]; p< 0.001), thromboembolic events (HR 0.15, 95% CI [0.05–0.50]; p=0.002), and permanent pacemaker implantation (HR 0.22, 95% CI [0.07–0.64]; p=0.006) (Table 1). Conclusion