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Ross procedure tops prosthetic aortic valve replacement in younger adults

Journal of the American College of Cardiology
Reuters Health - 25/02/2022 - For younger adults undergoing primary aortic valve replacement (AVR), the Ross procedure leads to improved survival and better outcomes compared to prosthetic AVR, according to a large study from New York.

With the Ross procedure, the diseased aortic valve is replaced with a pulmonary autograft and placement of a homograft or xenograft in the pulmonary position.

Prosthetic AVR involves use of either a mechanical valve, which requires lifelong anticoagulation, or a biological valve from a human or animal donor, which has limited durability.

Survival with the Ross procedure was not only better than after biological or mechanical AVR, it was identical to age-, sex- and race-matched adults in the general population who did not have AVR surgery.

"To this day, this is the only operation that has ever been shown to restore survival after aortic valve replacement in young adults," lead researcher Dr. Ismail El-Hamamsy, professor of cardiovascular surgery at the Icahn School of Medicine at Mount Sinai and director of aortic surgery for the Mount Sinai Health System, said in a news release.

"This is a huge deal because it demonstrates the impact of valve choice in the long term. However, there is an important word of caution: the Ross procedure is a more complex operation and should only be performed in Ross centers of excellence. When done in that setting, this represents a major breakthrough for young patients with aortic valve disease, including young women contemplating pregnancy," Dr. El-Hamamsy said.

The findings are based on a propensity-matched analysis of 1,302 patients between 18 and 50 years old who underwent the Ross procedure, a biological valve replacement, or a mechanical valve replacement (434 patients per group).

At 15 years, survival was 93.2% with the Ross procedure, versus 87.9% and 88.4%, respectively, with biological and mechanical AVR. The Ross procedure was associated with significantly lower risk of mortality compared to biological AVR (hazard ratio: 0.42) and to mechanical AVR (HR: 0.45), according to the Journal of the American College of Cardiology report.

At 15 years, the Ross procedure was also associated with a significantly lower risk of stroke or major bleeding than a mechanical valve (3.8% vs 13%), and with significantly fewer repeat surgeries (17% vs 30%) and endocarditis (2.3% vs 8.5%) than a biological valve.

At 15 years, however, the risk of reoperation was higher after the Ross procedure than after mechanical AVR (17% vs 7.4%).

"This study demonstrates that while there is a definite risk of reoperation after the Ross procedure, the associated risk is low. In other words, this should be seen as a bump on the road, rather than the end of the road. In contrast, if patients suffer a stroke, hemorrhage, or infection, the consequences are much more dire," Dr. El-Hamamsy said in the news release.

"Patients should be given all this data so they can make truly informed decisions about these major life events. Ultimately, the day, the Ross procedure is associated with better survival and fewer complications," Dr. El-Hamamsy said.

The study had no specific funding and the authors have declared no relevant conflicts of interest.

SOURCE: https://bit.ly/3BQjCyk Journal of the American College of Cardiology, online February 21, 2022.

By Reuters Staff

© 2023 The Author(s). Published by Medicom Medical Publishers.
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