The Ross procedure is the optimal solution for young adults with unrepairable aortic valve disease

Abstract

While aortic valve repair remains the ideal intervention to restore normal valvular function, the optimal aortic valve substitute for patients with a non-repairable aortic valve remains an ongoing subject for debate. In particular, younger patients with a non-repairable valve represent a unique challenge because of their active lifestyle and long life expectancy, which carries a higher cumulative risk of prosthesis-related complications. The Ross procedure, unlike prosthetic or homograft aortic valve replacement (AVR), provides an expected survival equivalent to that of the age and gender-matched general population. Contemporary data has shown that the Ross procedure can be performed safely in centers with expertise, and is associated with improved valvular durability, hemodynamics and quality of life.

Ross procedure versus pulmonary homograft versus mechanical valve versus bioprosthetic valve versus Ozaki procedure for surgical aortic valve replacement: a frequentist network meta-analysis

“…In line with prior literature, we demonstrated a mortality benefit with the Ross procedure compared to MV and BV at long-term follow-up [ 24 , 25 ]. Widely praised for its ability to provide comparable post-operative life expectancy to that of the matched general population [ 26 ], the pulmonary autograft’s utilization provides patients with a conduit capable of adaptive remodeling to the mobile native aortic root and preservation of native hemodynamic and contractile properties [ 27 ]. Also of note, when deeply positioning the autograft within the left ventricular outflow tract, the Ross procedure helps confer a lower risk of severe patient-prosthesis mismatch, which carries a higher risk of morbidity and mortality [ 28 ].…”