Ross Procedure for Aortic Valve Replacement in Young Adults
Preferred Procedure or “Double, Double Toil and Trouble”?
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Article, see p 576
Since the original description of aortic valve replacement (AVR) with a pulmonary autograft by Donald Ross in 1967,1 cardiac surgeons have had an uneasy relationship with this method for managing aortic valve disease. In many patients, the implanted autograft functions normally with no evidence of late deterioration, and thus is an ideal valve substitute. The Ross procedure has a special advantage in young children, because the implanted autograft can enlarge with somatic growth.2 However, the operation is more complicated than standard prosthetic AVR because of the need for careful dissection during harvest of the pulmonary artery graft, the requirement for precise alignment of the graft within the aortic root, and the added potential for late dysfunction of the homograft or heterograft used to replace the native pulmonary valve.
The study in this issue of Circulation by Mazine and associates from Toronto provides information on 208 patients who were followed for an average of 13.6 years after a Ross procedure.3 The investigation is especially useful because of the comparison with a propensity-matched cohort of 208 patients who had AVR with mechanical bileaflet prostheses. The authors found no difference in long-term survival between the 2 groups, but patients who had the Ross procedure had better long-term freedom from cardiac-related morbidity and mortality than those having mechanical AVR. These findings are important, but may have been predicted from other comparative studies that also show similar survival of patients with Ross procedure versus mechanical AVR.4 The increased hazard of thromboembolism and bleeding from systemic anticoagulation with warfarin are well-known complications of mechanical prostheses. So, what is unique in the report and …