AVR in young: Is Ross procedure the perfect answer? Study reports excellent outcomes
JAMA Cardiology: There is no perfect prosthetic valve substitute for young and middle-aged patients requiring aortic valve replacement (AVR). The long-term risks of anticoagulation with a mechanical prosthesis must be weighed against the risks of structural valve deterioration of a bioprosthetic valve. In patients aged 20 to 40 years, the decision almost always leads to the selection of a mechanical valve and lifelong anticoagulation. Against this background, Romeo et al have now reported robust survival rates post-Ross procedure in long-term with very low rates of reoperation for either aortic autograft or pulmonary homograft failure and excellent hemodynamics.
To determine the long-term clinical and echocardiographic outcomes in young and middle-aged patients (18-65 years) undergoing the Ross procedure, a retrospective multicenter international cohort study with a median follow-up period of 9.2 years was conducted in 5 experienced centers regularly performing the Ross procedure.
Implantation techniques were root inclusion in 24.9%, root replacement in 485 34.0%, and subcoronary implantation 41.1%. Right ventricular outflow tract reconstruction was performed with homografts in 98.6% and bioprostheses in 1.4%.
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