Propensity-Matched Comparison of the Ross Procedure and Prosthetic Aortic Valve Replacement in Adults

El-Hamamsy, Ismaı̈l; Toyoda, Nana; Itagaki, Shinobu; Stelzer, Paul; Varghese, Robin; Williams, Elbert E.; Erogova, Natalia; Adams, David H.

doi:10.1016/j.jacc.2021.11.057

Cited by 81 publications

(75 citation statements)

References 22 publications

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“…Aortic valve and root replacement (AVRR) using a composite valve graft (CVG) as described by Bentall and De Bono (BD) in 1968 [ 1 ] has become (through various modifications) the gold standard in the treatment of aortic root pathologies with or without aortic valve (AV) disease [ 2 , 3 ]. Simultaneously, the Ross procedure was introduced, particularly for younger patients with similar pathologies [ 4 ]; its use has increased, based on strong evidence [ 5 , 6 ]. Two decades later, valve-sparing operations such as aortic root remodelling (the Yacoub procedure) [ 7 ] and AV reimplantation (the David procedure) [ 8 ] were introduced.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes after Aortic Valve and Root Replacement in a Very High-Risk Population

Hlavicka

Antonov

Salem

et al. 2022

JCDD

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Background: Aortic valve and root replacement (AVRR) is a standardised procedure to treat patients with aortic valve and root disease. In centres with a well-established aortic valve and root repair program (valve repairs and Ross operations), only patients with very complex conditions receive AVRR; this procedure uses a mechanical or biological composite valve graft (modified Bentall–de Bono procedure). The aim of the study was to evaluate the short- and long-term results after AVRR in a high-risk population with complex pathologies. Methods: Between 2005 and 2018, a total of 273 consecutive patients (mean age 64 ± 12.8 years; 23% female) received AVRR. The indication for surgery was an acute type A aortic dissection in 18%, infective endocarditis in 36% and other pathologies in 46% patients; 39% were redo procedures. The median EuroSCORE II was 11.65% (range 1.48–95.63%). Concomitant surgery was required in 157 patients (58%). Results: The follow-up extended to 5.2 years (range 0.1–15 years) and it was complete in 96% of the patients. The 30-day mortality was 17%. The overall estimated survival at 5 and 10 years was 65% ± 3% and 49% ± 4%, respectively. Univariate and multivariate logistic regression analyses revealed the following risk factors for survival: perioperative neurological dysfunction (OR 5.45), peripheral artery disease (OR 4.4) and re-exploration for bleeding (OR 3.37). Conclusions: AVRR can be performed with acceptable short- and long-term results in a sick patient population. The Bentall–De Bono procedure may be determined to be suitable for only elderly or high-risk patients. Any other patients should receive an AV repair or the Ross procedure in well-established centres.

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Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes after Aortic Valve and Root Replacement in a Very High-Risk Population

Hlavicka

Antonov

Salem

et al. 2022

JCDD

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“…Also, at 15 years, actual survival after the Ross procedure was 93.1% (95% CI: 89.1%-95.7%), similar to that of the age-, sex-, and race-matched U.S. general population. It was significantly lower after biological AVR (HR: 0.42; 95% CI: 0.23-0.075; p = 0.003) and mechanical AVR (HR: 0.45; 95% CI: 0.26-0.79; p = 0.006) [29]. Other studies have also reported excellent long term survival data similar to that of the general population (ageand sex-matched), unlike prosthetics, mechanical or biological, that cannot restore normal life expectancy in young patients undergoing an aortic valve replacement [13,18,[30][31][32].…”

Section: The Ross Proceduresmentioning

confidence: 97%

Biological Surgical Options in Young Patients for the Treatment of Severe Aortic Stenosis: Is the Jury Still Out? A Review

Khalil¹,

Forcillo²

2022

Rev. Cardiovasc. Med.

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Aortic interventions remain the most effective treatment for severe aortic stenosis. In the recent years, advances in bioprosthetics and newer data have reduced the cut-off age for the use of bioprosthetic valves in younger patients, but the debate on whether to favor mechanical valves in younger patients remains a constant, especially with the undesired effects and considerations of anticoagulation therapy with vitamin K antagonists in this age group. Other options like the Ross procedure are gaining traction, despite still being undervalued and necessitating expertise centers. Hemodynamic considerations and durability of these options are important to consider, especially in this age group. Regardless of the choice of the prosthesis, patient informed consent is paramount since the decision affects the lifetime management of their initial condition, and expectations given must remain realistic.

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“…Preoperative evaluation showed normal biventricular function, no evidence of coronary artery disease and an ascending aorta of 3.5 cm. Elective Ross procedure using a total root technique was therefore scheduled ( 1 ).…”

Section: Clinical Vignettementioning

confidence: 99%

The Ross procedure for bicuspid aortic valve: total root implantation technique

Yammine¹,

Williams²,

El-Hamamsy³

2022

Ann Cardiothorac Surg

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Propensity-Matched Comparison of the Ross Procedure and Prosthetic Aortic Valve Replacement in Adults

Cited by 81 publications

References 22 publications

Long-Term Outcomes after Aortic Valve and Root Replacement in a Very High-Risk Population

Long-Term Outcomes after Aortic Valve and Root Replacement in a Very High-Risk Population

Biological Surgical Options in Young Patients for the Treatment of Severe Aortic Stenosis: Is the Jury Still Out? A Review

The Ross procedure for bicuspid aortic valve: total root implantation technique

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