title: Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial.
abstract: BACKGROUND
  The ideal substitute for aortic valve replacement in patients with aortic valve disease is not known. Our hypothesis was that the regulatory and adaptive properties of a living valve substitute could improve the long-term outcomes in patients. We therefore compared these outcomes after autograft aortic root replacement (Ross procedure) versus homograft aortic root replacement in adults.
  
  
  METHODS
  Male and female patients (<69 years) requiring aortic valve surgery were randomly assigned in a one-to-one ratio to receive an autograft or a homograft aortic root replacement in one centre in the UK. The random allocation sequence was computer generated. Treatment was not masked. The primary endpoint was survival of patients at 10 years after surgery. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN03530985.
  
  
  RESULTS
  228 patients were randomly assigned to receive an autograft or a homograft aortic root replacement. 12 patients were excluded because they were younger than 18 years; 108 in each group received the surgery they were assigned to and were analysed. There was one (<1%) perioperative death in the autograft group versus three (3%) in the homograft group (p=0.621). At 10 years, four patients died in the autograft group versus 15 in the homograft group. Actuarial survival at 10 years was 97% (SD 2) in the autograft group versus 83% (4) in the homograft group. Hazard ratio for death in the homograft group was 4.61 (95% CI 1.71-16.03; p=0.0060). Survival of patients in the autograft group was similar to that in an age-matched and sex-matched British population (96%).
  
  
  CONCLUSIONS
  Our findings support the hypothesis that a living valve implanted in the aortic position can significantly improve the long-term outcomes in patients.
  
  
  BACKGROUND
  Funding Magdi Yacoub Institute.
authors.affiliation: Department of Cardiac Surgery, Royal Brompton and Harefield NHS Trust, London, UK.
authors.forename: Ismail
authors.initials: I
authors.lastname: El-Hamamsy
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Eryigit
authors.forename: Louis-Mathieu
authors.initials: LM
authors.lastname: Stevens
authors.forename: Zubair
authors.initials: Z
authors.lastname: Sarang
authors.forename: Robert
authors.initials: R
authors.lastname: George
authors.forename: Lucy
authors.initials: L
authors.lastname: Clark
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melina
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000637:transplantation*; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D015996:Survival Rate; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult