Ross Procedure vs Mechanical Aortic Valve Replacement in Adults

Mazine, Amine; Rocha, Rodolfo V.; El-Hamamsy, Ismaı̈l; Ouzounian, Maral; Yanagawa, Bobby; Bhatt, Deepak L.; Verma, Subodh; Friedrich, Jan O.

doi:10.1001/jamacardio.2018.2946

Cited by 72 publications

(44 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our meta-analysis is in line with other recent findings, namely by Mazine et al 30 and McClure et al 31. Both found that the Ross procedure had generally better outcomes compared with biological AVR or mechAVR.…”

Section: Discussionsupporting

confidence: 93%

Clinical and cost-effectiveness of the Ross procedure versus conventional aortic valve replacement in young adults

et al. 2019

View full text Add to dashboard Cite

ObjectivesIn young and middle-aged adults, there are three current options for aortic valve replacement (AVR), namely mechanical AVR (mechAVR), tissue AVR (biological AVR) and the Ross operation, with no clear guidance on the best option. We aim to compare the clinical effectiveness and cost-effectiveness of the Ross procedure with conventional AVR in young and middle-aged adults.MethodsThis is a systematic literature review and meta-analysis of AVR options. Markov multistate model was adopted to compare cost-effectiveness. Lifetime costs, quality-adjusted life years (QALYs), net monetary benefit (NMB), population expected value of perfect information (EVPI) and expected value of partial perfect information were estimated.ResultsWe identified 48 cohorts with a total number of 12 975 patients (mean age 44.5 years, mean follow-up 7.1 years). Mortality, bleeding and thromboembolic events over the follow-up period were lowest after the Ross operation, compared with mechAVR and biological AVR (p<0.001). Aortic reoperation rates were lower after Ross compared with biological AVR, but slightly higher when compared with mechAVR (p<0.001). At a willingness-to-pay threshold of £20effective. At a willingness-to-pay threshold of £20, 000 per QALY000 per QALY, the Ross procedure is more cost-effective compared the Ross procedure is more cost-effective compared withwith conventional AVR, with a lifetime incremental NMB of £60 conventional AVR, with a lifetime incremental NMB of £60 952 (952 (££3030 236236 to to ££7979 464). Incremental costs were £12464). Incremental costs were £12 323 (323 (££61086108 to to ££1515 972) and incremental QALYs 3.66 (1.81972) and incremental QALYs 3.66 (1.81 to to 4.76). The population EVPI indicates that a trial costing up to £2.03 million could be cost 4.76). The population EVPI indicates that a trial costing up to £2.03 million could be cost--effective.At a willingness-to-pay threshold of £20 000 per QALY, the Ross procedure is more cost-effective compared with conventional AVR, with a lifetime incremental NMB of £60 952 (£30 236 to £79 464). Incremental costs were £12 323 (£6108 to £15 972) and incremental QALYs 3.66 (1.81 to 4.76). The population EVPI indicates that a trial costing up to £2.03 million could be cost-effective.ConclusionsIn young and middle-aged adults with aortic valve disease, the Ross procedure may confer greater quality of life and be more cost-effective than conventional AVR. A high-quality randomised trial could be warranted and cost-effective.

show abstract

Section: Discussionsupporting

confidence: 93%

Clinical and cost-effectiveness of the Ross procedure versus conventional aortic valve replacement in young adults

et al. 2019

View full text Add to dashboard Cite

show abstract

“…1 Especially in young patients, the Ross operation improves quality of life and increases survival when compared with mechanical valve substitutes. 2 These findings are related to the advantages of the living pulmonary autograft being implanted in the aortic position.…”

Section: Reply: Why Still Iib and C? Reply To The Editormentioning

confidence: 99%

“…(Class IIb recommendation, level of evidence C). 6 Given that there is increasing evidence that the Ross operation is the best procedure to treat aortic valve stenosis in young and middle-aged adults, [1][2][3][4]7,8 one can argue that the guideline level of recommendation should be increased. This has been addressed by surgical experts of the Ross procedure already in 2014.…”

Section: Reply: Why Still Iib and C? Reply To The Editormentioning

confidence: 99%

“…The question is whether the autograft can adapt to the new conditions for adequate lifelong function, which is excellent over at least 20 years after the operation albeit with some late decline in function. 2 Root dilatation and leaflet prolapse causing regurgitation are obviously surgically related reasons for nonstructural valve degeneration. But there must be other factors resulting in increasing regurgitation by structural valve degeneration, which was observed in explant studies showing a thickening of autograft leaflets even many years after the operation.…”

Section: Reply: Does Adaptation Prevent Calcification?mentioning

confidence: 99%

“…This might explain in part that over the years in some patients there is a loss of functional excellence especially in patients with primary insufficiency. 2 Whether the adaptation mechanisms in the Ross autograft are adequate for generating a perfect ''normal'' aortic valve in all patients or at all and whether they are protective against calcification remains elusive and questionable probably requiring longer follow-up times for clarification. What we can learn is that surgery and especially Ross surgery should be absolutely precise in form and function to imitate nature, thereby reducing the stress on the autograft, which might be beneficial for adaptation with less degeneration over longer time periods.…”

Section: Reply: Does Adaptation Prevent Calcification?mentioning

confidence: 99%

See 2 more Smart Citations

Reply: Why Still IIB And C?

Misfeld

Borger

2020

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

The Ross Operation Comes of Age

Yacoub

2018

JAMA Cardiol

View full text Add to dashboard Cite

Approximately 50 years ago, I witnessed the birth of the Ross operation at the National Heart Hospital in London, United Kingdom, and began to watch it grow. There have been many so-called growing pains, but as is usual, these represent a passing phase. The origins of the operation stems from the hypotheses, advanced by Donald Ross, MB, ChB, FRCS, that a living valve substitute is essential for the valve's long-term performance, the normal pulmonary valve shares many structural and functional characteristics with the normal aortic valve, and substitution had to be autologous to avoid rejection. These ideas were greeted by great skepticism. It has taken about 50 years to prove that Ross was right on all 3 accounts. [1][2][3][4] Despite that, use of the Ross operation remained extremely low until very recently. This was thought by many experienced workers to be a lost opportunity. 5 The article by Mazine et al 6 in this issue of JAMA Cardiology is a welcome addition to the accumulating evidence of the superiority of the Ross operation. The authors present the first and to my knowledge only meta-analysis comparing outcomes of the Ross operation with those of mechanical prostheses (currently the recommended and most common aortic valve substitute) in young and middle-aged adults. For the analysis, the authors used several important solid end points, including survival, quality of life, hemodynamic performance, and changes in left ventricular size and function, as well as frequency of reoperation. The Ross operation outperformed mechanical valves at all end points except for the frequency of reoperation, which was marginally increased relative to mechanical protheses. Fortunately, the causes of reoperation are largely preventable and, when they occur, can

show abstract

Ross Procedure vs Mechanical Aortic Valve Replacement in Adults

Abstract: IMPORTANCE The ideal aortic valve substitute in young and middle-aged adults remains unknown. OBJECTIVE To compare long-term outcomes between the Ross procedure and mechanical aortic valve replacement in adults.

Cited by 72 publications

References 66 publications

Clinical and cost-effectiveness of the Ross procedure versus conventional aortic valve replacement in young adults

Clinical and cost-effectiveness of the Ross procedure versus conventional aortic valve replacement in young adults

Reply: Why Still IIB And C?

The Ross Operation Comes of Age

Contact Info

Product

Resources

About