Long-Term Outcomes of the Ross Procedure Versus Mechanical Aortic Valve Replacement Propensity-Matched Cohort Study

作者：Mazine Amine; David Tirone E; Rao Vivek; Hickey Edward J; Christie Shakira; Manlhiot Cedric; Ouzounian Maral^*

来源：Circulation, 2016, 134(8): 576-585.

DOI：10.1161/CIRCULATIONAHA.116.022800

• aortic valve
• propensity score
• surgery
• treatment outcome

BACKGROUND: The ideal aortic valve substitute in young and middle-aged adults remains unknown. We sought to compare the long-term outcomes of patients undergoing the Ross procedure and those receiving a mechanical aortic valve replacement (AVR).
METHODS: From 1990 to 2014, 258 patients underwent a Ross procedure and 1444 had a mechanical AVR at a single institution. Patients were matched into 208 pairs through the use of a propensity score. Mean age was 37.2 +/- 10.2 years, and 63% were male. Mean follow-up was 14.2 +/- 6.5 years.
RESULTS: Overall survival was equivalent (Ross versus AVR: hazard ratio, 0.91, 95% confidence interval, 0.38-2.16; P=0.83), although freedom from cardiac-and valve-related mortality was improved in the Ross group (Ross versus AVR: hazard ratio, 0.22; 95% confidence interval, 0.03-40.86; P=0.03). Freedom from reintervention was equivalent after both procedures (Ross versus AVR: hazard ratio, 1.86; 95% confidence interval, 0.76-4.94; P=0.18). Long-term freedom from stroke or major bleeding was superior after the Ross procedure (Ross versus AVR: hazard ratio, 0.09; 95% confidence interval, 0.02-0.31; P<0.001).
CONCLUSIONS: Long-term survival and freedom from reintervention were comparable between the Ross procedure and mechanical AVR. However, the Ross procedure was associated with improved freedom from cardiacand valve-related mortality and a significant reduction in the incidence of stroke and major bleeding. In specialized centers, the Ross procedure represents an excellent option and should be considered for young and middle-aged adults undergoing AVR.

• 出版日期2016-8-23