The Ross procedure was associated with lower 6-year mortality compared to biological SAVR in adults under 65 (HR 0.42; 95% CI 0.19-0.91), whereas TAVR was associated with higher mortality.
Observational
Yes
Does the Ross procedure, TAVR, or mechanical SAVR improve 6-year outcomes compared to biological SAVR in adults 18-64 years old requiring aortic valve replacement?
In adults under 65 requiring aortic valve replacement, the Ross procedure is associated with lower 6-year mortality compared to biological SAVR or TAVR, supporting its broader consideration in younger patients.
Effect estimate: HR 0.42 (95% CI 0.19-0.91)
BACKGROUND Transcatheter aortic valve replacement (TAVR) use among patients<65 has risen rapidly, coinciding with renewed interest in the Ross procedure for aortic stenosis. This observational cohort study evaluated temporal trends in Ross, TAVR, and surgical aortic valve replacement (SAVR) utilization and compared their 6-year outcomes in adults 18-64 years old. METHODS We used California and New York discharge data (2000-2025) to identify patients undergoing Ross, TAVR, mechanical (SAVR-mech), or biological SAVR (SAVR-bio). Multivariable time-to-event models assessed the 6-year risks of death, myocardial infarction, stroke, infective endocarditis (IE), reintervention, and pacemaker implantation. RESULTS Ross utilization declined from 2.8% in 2000 to 0.9% in 2005, then rebounded to 2.8% by 2022. TAVR expanded rapidly after 2011, while SAVR-mech declined and SAVR-bio plateaued after 2017. Early mortality was low across all groups, and notably rare following the Ross procedure. Compared with SAVR-bio, the Ross procedure was associated with lower adjusted 6-year mortality (HR:0.42 95%CI:0.19-0.91) and stroke risk. The risk of isolated aortic valve reintervention and aortic and/or pulmonary valve reintervention was higher after Ross and SAVR-mech than SAVR-bio but remained lower after TAVR. TAVR was associated with higher mortality (HR:1.4895% CI:1.07-2.05), IE, and heart failure hospitalization compared with SAVR-bio. SAVR-mech demonstrated comparable survival to SAVR-bio (HR:0.9695% CI:0.85-1.08) but higher risks of IE, myocardial infarction, heart failure, and pacemaker implantation. CONCLUSIONS Ross use in adults<65 is rising and confers lower 6-year mortality rates than SAVR-bio or TAVR, supporting broader consideration for younger patients.
Alabbadi et al. (2026) conducted an observational in Aortic stenosis. Ross procedure, TAVR, and mechanical SAVR vs. Biological SAVR (SAVR-bio) was evaluated on 6-year mortality (HR 0.42, 95% CI 0.19-0.91). The Ross procedure was associated with lower 6-year mortality compared to biological SAVR in adults under 65 (HR 0.42; 95% CI 0.19-0.91), whereas TAVR was associated with higher mortality.