Key result
Ross procedure for BAV with pure AR achieves ~85% 20-year freedom from redo AVR and >mild AR.
Why the study?
Does the Ross procedure provide acceptable long-term freedom from reoperation and survival in adults with bicuspid aortic valve and pure aortic regurgitation?
Cohort (n=129)
No
Does the Ross procedure provide acceptable long-term freedom from reoperation and survival in adults with bicuspid aortic valve and pure aortic regurgitation?
The Ross procedure in adults with bicuspid aortic valve and pure aortic regurgitation demonstrates excellent long-term outcomes, with 85% freedom from reoperation at 20 years, challenging current guidelines that advise against its use in this population.
May support consideration in selected adults with BAV and pure AR; extends observational data challenging current guideline restrictions.
OBJECTIVES: The Ross procedure has demonstrated excellent results when performed in patients with aortic stenosis or mixed aortic valve disease [aortic stenosis and aortic regurgitation (AR)]. However, due to its reported risk of late reoperation, it is not recommended under current guidelines for patients presenting with bicuspid aortic valve and pure AR. We have analysed our own results in light of this recommendation. METHODS: Between 1993 and 2016, 129 consecutive patients with a mean age of 34.7 ± 10.6 years (range 16-64 years) presented with bicuspid aortic valve and pure AR and underwent the Ross procedure. Patients were reviewed annually and had 2nd yearly transthoracic echocardiograms during follow-up. The unit had a liberal reoperation policy where reoperation was performed if patients developed recurrent moderate or greater AR during follow-up. RESULTS: There was 1 inpatient death, and 3 late deaths over a mean follow-up duration of 9.6 ± 6.8 years. Late survival at 10 and 20 years post-surgery were 99% [95% confidence interval (CI) 94-100] and 95% (95% CI 85-99), respectively. Eleven patients underwent redo aortic valve replacement (AVR) and 4 patients had redo pulmonary valve replacement. Freedom from reoperation for AVR and more-than-mild AR at 10 and 20 years post-surgery were 89% (95% CI 81-94) and 85% (95% CI 74-92), respectively. Having longer aortic cross-clamp (hazard ratio 1.03, 95% CI 1.00-1.06; P = 0.05) and cardiopulmonary bypass times (hazard ratio 1.02, 95% CI 1.00-1.05; P = 0.05), and having a larger preoperative sinotubular junction diameter (hazard ratio 1.15, 95% CI 1.03-1.30; P = 0.02) were significant predictors of having redo AVR or significant AR at follow-up. CONCLUSIONS: With a 20-year freedom from redo AVR and greater-than-mild residual AR of 85%, the utilization of the Ross procedure in bicuspid aortic valve patients with pure AR should be considered.
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Poh et al. (2018) conducted a cohort in Bicuspid aortic valve and pure aortic regurgitation (n=129). Ross procedure was evaluated on Freedom from reoperation for AVR and more-than-mild AR at 20 years (95% CI 74-92). The Ross procedure in patients with bicuspid aortic valve and pure aortic regurgitation achieved 85% freedom from redo aortic valve replacement and greater-than-mild residual AR at 20 years.
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