Do pulmonary autografts provide better outcomes than mechanical valves? A prospective randomized trial.
BACKGROUND
The objective of this study was to compare the performance of pulmonary autografts with mechanical aortic valves, in the treatment of aortic valve stenosis.


METHODS
Forty patients with aortic valve stenoses, and below the age of 55 years, were randomly assigned to receive either pulmonary autografts (n = 20) or mechanical valve (Edwards MIRA; Edwards Lifesciences, Irvine, CA) prostheses (n = 20). Clinical outcomes, left ventricular mass regression, effective orifice area, ejection fraction, and mean gradients were evaluated at discharge, 6 months, and one year after surgery. Follow-up was complete for all patients.


RESULTS
Hemodynamic performance was significantly better in the Ross group (mean gradient 2.6 mm Hg vs 10.9 mm Hg, p = 0.0005). Overall, a significant decrease in left ventricular mass was found one year postoperatively. However, there was no significant difference in the rate and extent of regression between the groups. There was one stroke in the Ross group and one major bleeding complication in the mechanical valve group. Both patients recovered fully.


CONCLUSIONS
In our randomized cohort of young patients with aortic valve stenoses, the Ross procedure was superior to the mechanical prostheses with regard to hemodynamic performance. However, this did not result in an accelerated left ventricular mass regression. Clinical advantages like reduced valve-related complications and lesser myocardial strain will have to be proven in the long term.
Doss
Mirko
M
Department of Thoracic and Cardiovascular Surgery, J. W. Goethe University, Frankfurt am Main, Germany. mirkodoss@aol.com
Wood
Jeffrey P
JP
Martens
Sven
S
Wimmer-Greinecker
Gerhard
G
Moritz
Anton
A
D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000637:transplantation*