Ross procedure best option for young adults requiring aortic valve replacement: JAMA

There is no ideal valve substitute for young adults requiring aortic valve replacement. Multicenter data supporting use of the Ross procedure with respect to long-term postoperative valve–related mortality and reintervention, as well as function of the autograft and pulmonary homograft, are needed.

Therefore, Jamie L. R. Romeo and colleagues from the Department of Cardio-Thoracic Surgery Erasmus Medical Centre, Rotterdam, the Netherlands carried out this study with the sole objective to To determine the long-term clinical and echocardiographic outcomes in young and middle-aged patients undergoing the Ross procedure.

The authors conducted a retrospective multicenter international cohort study with a median follow-up period of 9.2 years in 5 experienced centers regularly performing the Ross procedure. Consecutive patients aged 18 to 65 years were included. Serial echocardiographic measurements of valve function were analyzed using mixed-effects modeling.

The results showed that-

a. During the study period, 1431 patients (74.3% men; n = 1063) were operated on at a median age of 48.5 years (mean [SD], 47.7 [9.5]; range, 18.1-65; interquartile range, 42.7-54.0).

b. Implantation techniques were root inclusion in 355 (24.9%), root replacement in 485 (34.0%), and subcoronary implantation in 587 (41.1%).

c. Right ventricular outflow tract reconstruction was performed with homografts in 98.6% (n = 1189) and bioprostheses in 1.4% (n = 17).

d. Ten patients (0.7%) died before discharge.

e. Median follow-up was 9.2 years (13 015 total patient-years).

f. Survival after 10 and 15 years was 95.1% (95% CI, 93.8%-96.5%) and 88.5% (95% CI, 85.9%-91.1%), respectively.

g. Freedom from autograft and homograft reintervention after 15 years was 92.0% and 97.2%, respectively. Late events were autograft endocarditis in 14 patients (0.11% per patient-year), homograft endocarditis in 11 patients (0.08% per patient-year), and stroke in 37 patients (0.3% per patient-year).

Hence, the authors concluded that "Given its excellent short-term and long-term outcome in young and middle-aged adults in this study, the Ross procedure should be considered in young and middle-aged adults who require aortic valve replacement."

Patients should be referred to an experienced center with a program dedicated to the Ross procedure, they further added.