Abstract 17006: Mechanical Aortic Valve Replacement is Associated With Superior Long Term Survival but Equivalent Cardiovascular Mortality Compared to the Ross Operation, at the Cost of an Increased Risk of Hospital Readmissions for Cardiac and Bleeding Causes
Introduction: The Ross operation is an attractive alternative to mechanical aortic valve replacement in young adults. The main potential advantages are: no need of anticoagulation, better quality of life and excellent hemodynamics.
Hypothesis: We assessed the hypothesis that long-term survival after a Ross procedure should be comparable to that after mechanical aortic valve replacement. Nevertheless, we also hypothesized a different incidence of valve-related and anticoagulation-related complications within the 2 groups.
Methods: Between 1985 and 2014,422 consecutive patients received a Ross procedure at our Institution. Of these patients, we considered only the cases of isolated Ross operation performed in patients between 18 and 60 years. We excluded reoperations and patients with aortic dissection. A propensity score matching with bootstrap analysis was performed to compare the Ross group with a second group of patients who had a mechanical replacement of the aortic valve and/or root during the same period (n = 152 each group). Early and long-term outcomes including survival, readmission for bleeding and cardiovascular causes were compared. Follow-up was complete. Administrative provincial vital statistics and hospital readmission data has been used to analyze for the long-term outcomes up to 29 years. Mean follow-up was 12.6 years ±6.6 for the Ross group and 9.6 years ± 6.9 for the mechanical aortic valve replacement group.
Results: Mean age of the matched cohort was 45.2±0.2 years in the Ross procedure group and 45.7±0.3 years in the mechanical valve group. In-hospital mortality was comparable between the 2 groups (OR=0.67, 95%CI=0.47-4.76). Long-term survival was superior in the mechanical valve group (HR= 0.64, 95%CI=0.44-0.93) compared to the Ross procedure group, but cardiovascular mortality was equivalent (HR= 1.12, 95%CI= 0.71-1.77). However, hospital readmissions for cardiac causes (HR= 1.28, 95%CI= 1.06-1.54) and bleeding events (HR 5.05, 95%CI=2.78-9.09) were significantly higher in the mechanical aortic valve group.
Conclusions: In comparable patients, there is a late survival advantage for the mechanical valve replacement over the Ross procedure when all causes of mortality are considered, while cardiovascular survival is equivalent in the two groups. However, the risk of hospital readmissions for cardiac causes and bleeding events remains higher in case of mechanical valve replacement.
Author Disclosures: N. Vistarini: None. D. Kalavrouziotis: None. J. Perron: None. F. Dagenais: None. E. Dumont: None. P. Voisine: None. S. Mohammadi: None.
- © 2016 by American Heart Association, Inc.