Long-Term Outcomes of the Ross Procedure versus Mechanical Aortic Valve Replacement: Propensity-Matched Cohort Study
Background—The ideal aortic valve substitute in young and middle-aged adults remains unknown. We sought to compare the long-term outcomes of patients undergoing the Ross procedure vs. mechanical aortic valve replacement (AVR).
Methods—From 1990 to 2014, 258 patients underwent a Ross procedure and 1,444 a mechanical AVR at a single institution. Patients were matched into 208 pairs using a propensity score. Mean age was 37.2±10.2 years and 63% were male. Mean follow-up was 14.2±6.5 years.
Results—Overall survival was equivalent (Ross vs. AVR: HR 0.91, 95% CI [0.38-2.16]; p=0.83), although freedom from cardiac and valve-related mortality was improved in the Ross group (Ross vs. AVR: HR 0.22, 95% CI [0.034-0.86]; p=0.03). Freedom from reintervention was equivalent following both procedures (Ross vs. AVR: HR 1.86, 95% CI [0.76-4.94]; p = 0.18). Long-term freedom from stroke or major bleeding was superior after the Ross procedure (Ross vs. AVR: HR 0.09, 95% CI [0.02-0.31]; p<0.001).
Conclusions—Long-term survival and freedom from reintervention were comparable between the Ross procedure and mechanical AVR. However, the Ross procedure was associated with improved freedom from cardiac and valve-related mortality as well as a significant reduction in the incidence of stroke and major bleeding. In specialized centers, the Ross procedure represents an excellent option and should be considered for young and middle-aged adults undergoing AVR.
- Received April 2, 2016.
- Revision received June 20, 2016.
- Accepted July 1, 2016.