Key result
Ross operation shows no benefit over bioprosthesis for 15-year aortic valve reoperation in young women.
Why the study?
The most appropriate valve substitute at aortic valve replacement for young female adult patients wanting to have children is unclear.
Does the Ross operation improve freedom from aortic valve reoperation and pregnancy outcomes compared to bioprosthetic valve replacement in young female adults wanting to have children?
Cohort (n=21)
No
Does the Ross operation improve freedom from aortic valve reoperation and pregnancy outcomes compared to bioprosthetic valve replacement in young female adults wanting to have children?
The Ross operation appears to be an ideal option for young women wanting children, demonstrating excellent long-term durability and safe perinatal outcomes without autograft stenosis.
May support Ross consideration in young women planning pregnancy; leaves open need for randomized confirmation of durability.
BACKGROUND The most appropriate valve substitute at aortic valve replacement (AVR) for young female adult patients wanting to have children is unclear. METHODSANDRESULTS Between 1992 and 2013, 12 consecutive female patients aged >18 (median, 22.5 years; range, 18-34 years) underwent Ross operation (Ross group). Between 1984 and 2013, 9 consecutive female patients aged >18 (median, 30 years; range, 22-39 years) underwent AVR with bioprosthesis (bioprosthesis group). There was 1 late mortality in the bioprosthesis group, due to prosthetic valve endocarditis (PVE). Freedom from reoperation for aortic valve at 15 years was 90.0% in the Ross group, and 57.1% in the bioprosthesis group (log-rank, P=0.098). One in the Ross group underwent reoperation for aortic regurgitation (AR), whereas 4 in the bioprosthesis group did so for aortic stenosis (AS) in 2, combined AS and AR in 1, and PVE in 1. Five patients in the Ross group and 3 in the bioprosthesis group had 7 and 4 uneventful pregnancies, respectively. AR progressed during the perinatal period in a total of 7 of 11 pregnancies. No AS was seen at discharge, after 5 years, or during pregnancy in the Ross group. CONCLUSIONS The long-term outcome of Ross operation for female patients wanting to have children is excellent. Although subclinical pulmonary autograft valve regurgitation during pregnancy was often observed, pulmonary autograft stenosis did not occur, therefore it would be an ideal option for patients wanting to have children.
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Morimoto et al. (2015) conducted a cohort in Aortic valve disease requiring surgery in women desiring pregnancy (n=21). Ross operation vs. Aortic valve replacement with bioprosthesis was evaluated on Freedom from reoperation for aortic valve at 15 years (p=0.098). The Ross operation demonstrated a 90.0% freedom from reoperation for the aortic valve at 15 years compared to 57.1% for bioprosthesis (p=0.098) in young female adult patients wanting to have children.
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