PhD Student Institut universitaire de cardiologie et de pneumologie de Québec - ULaval, Quebec, Canada
Background: The Ross procedure is an attractive alternative treatment option for young patients requiring aortic valve replacement (AVR). However, it remains technically more complex than a standard AVR as it involves surgical intervention on two heart valves. Thus, the ideal valve substitute in young adults remains a matter of debate.
METHODS AND RESULTS: This retrospective analysis was performed using prospectively collected data. A total of 1780 patients who underwent isolated AVR at the Institut universitaire de cardiologie et de pneumologie de Québec – ULaval from 1990 to 2023 were included (675 [38%] mechanical AVR, 711 [40%] biological AVR and 394 [22%] Ross procedure). Two separate propensity score matchings (PSM) were used to compare the Ross procedure with both mechanical and biological AVR. The primary study endpoint was all-cause mortality, and the key secondary endpoints were valve reintervention (on the aortic or pulmonary valve position), stroke, major bleeding and a composite endpoint of mortality and valve reintervention. At 30 years, there were no significant differences regarding mortality, valve reintervention and the composite endpoint between mechanical AVR and Ross procedure (log-rank p=0.84, log-rank p=0.72 and log-rank p=0.97, respectively). In contrast, biological AVR was associated with a significantly higher risk of valve reintervention and of the composite endpoint when compared to Ross (HR [95%CI]: 6.54 [3.57-11.99], p< 0.001 and HR [95%CI]: 3.44 [2.44-4.87], p< 0.001, respectively), but showed no difference regarding mortality (log-rank p=0.26). Mechanical AVR was associated with a higher incidence of bleeding (log-rank p=0.004, HR[95%CI]: 3.58 [1.42 - 9.04], p=0.007) and stroke (log-rank p< 0.001, HR[95%CI]: 2.86 [1.59-5.16], p< 0.001) compared to the Ross group, which was not observed in the biological AVR comparison.
Conclusion: At 30 years, the Ross procedure demonstrated similar survival and valve reintervention rates compared to mechanical AVR, with a significantly lower risk of bleeding and stroke. Compared to the Ross procedure, biological AVR was associated with lower risk of valve reintervention but similar results regarding mortality.
