The Ross procedure was associated with a reduced risk of late mortality (HR 0.34; 95% CI 0.17-0.67; P<0.001) and superior 20-year survival (94% vs 84%; P=0.018) compared with mechanical AVR.
Cohort (n=2,320)
Yes
Does the Ross procedure improve long-term survival compared with mechanical aortic valve replacement in patients aged 18 to 65 years?
In propensity-matched patients aged 18-65, the Ross procedure was associated with significantly better 20-year survival compared to mechanical aortic valve replacement.
Hazard Ratio: 0.34 (95% CI 0.17–0.67)
Absolute Event Rate: 94% vs 84%
p-value: p=<0.001
BACKGROUND: It is unclear whether the Ross procedure offers superior survival compared with mechanical aortic valve replacement (AVR). OBJECTIVES: This study evaluated experience and compared long-term survival between the Ross procedure and mechanical AVR. METHODS: Between 1992 and 2016, a total of 392 Ross procedures were performed. These were compared with 1,928 isolated mechanical AVRs performed during the same time period as identified using the University of Melbourne and Australia and New Zealand Society of Cardiac and Thoracic Surgeons' Cardiac Surgery Databases. Only patients between 18 and 65 years of age were included. Propensity-score matching was performed for risk adjustment. RESULTS: Ross procedure patients were younger, and had fewer cardiovascular risk factors. The Ross procedure was associated with longer cardiopulmonary bypass and aortic cross-clamp times. Thirty-day mortality was similar (Ross, 0.3%; mechanical, 0.8%; p = 0.5). Ross procedure patients experienced superior unadjusted long-term survival at 20 years (Ross, 95%; mechanical, 68%; p < 0.001). Multivariable analysis showed the Ross procedure to be associated with a reduced risk of late mortality (hazard ratio: 0.34; 95% confidence internal: 0.17 to 0.67; p < 0.001). Among 275 propensity-score matched pairs, Ross procedure patients had superior survival at 20 years (Ross, 94%; mechanical, 84%; p = 0.018). CONCLUSIONS: In this Australian, propensity-score matched study, the Ross procedure was associated with better long-term survival compared with mechanical AVR. In younger patients, with a long life expectancy, the Ross procedure should be considered in centers with sufficient expertise.
Buratto et al. (Thu,) conducted a cohort in Aortic valve disease (n=2,320). Ross procedure vs. Mechanical aortic valve replacement was evaluated on Long-term survival at 20 years (HR 0.34, 95% CI 0.17-0.67, p=<0.001). The Ross procedure was associated with a reduced risk of late mortality (HR 0.34; 95% CI 0.17-0.67; P<0.001) and superior 20-year survival (94% vs 84%; P=0.018) compared with mechanical AVR.