title: Survival comparison of the Ross procedure and mechanical valve replacement with optimal self-management anticoagulation therapy: propensity-matched cohort study.
abstract: BACKGROUND
  It is suggested that in young adults the Ross procedure results in better late patient survival compared with mechanical prosthesis implantation. We performed a propensity score-matched study that assessed late survival in young adult patients after a Ross procedure versus that after mechanical aortic valve replacement with optimal self-management anticoagulation therapy.
  
  
  RESULTS
  We selected 918 Ross patients and 406 mechanical valve patients 18 to 60 years of age without dissection, aneurysm, or mitral valve replacement who survived an elective procedure (1994 to 2008). With the use of propensity score matching, late survival was compared between the 2 groups. Two hundred fifty-three patients with a mechanical valve (mean follow-up, 6.3 years) could be propensity matched to a Ross patient (mean follow-up, 5.1 years). Mean age of the matched cohort was 47.3 years in the Ross procedure group and 48.0 years in the mechanical valve group (P=0.17); the ratio of male to female patients was 3.2 in the Ross procedure group and 2.7 in the mechanical valve group (P=0.46). Linearized all-cause mortality rate was 0.53% per patient-year in the Ross procedure group compared with 0.30% per patient-year in the mechanical valve group (matched hazard ratio, 1.86; 95% confidence interval, 0.58 to 5.91; P=0.32). Late survival was comparable to that of the general German population.
  
  
  CONCLUSIONS
  In comparable patients, there is no late survival difference in the first postoperative decade between the Ross procedure and mechanical aortic valve implantation with optimal anticoagulation self-management. Survival in these selected young adult patients closely resembles that of the general population, possibly as a result of highly specialized anticoagulation self-management, better timing of surgery, and improved patient selection in recent years.
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center, Room Bd 575, PO Box 2040, 3000 CA Rotterdam, the Netherlands. m.mokhles@erasmusmc.nl
authors.forename: M Mostafa
authors.initials: MM
authors.lastname: Mokhles
authors.forename: Heinrich
authors.initials: H
authors.lastname: Körtke
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stierle
authors.forename: Otto
authors.initials: O
authors.lastname: Wagner
authors.forename: Efstratios I
authors.initials: EI
authors.lastname: Charitos
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.forename: Jan
authors.initials: J
authors.lastname: Gummert
authors.forename: Hans-Hinrich
authors.initials: HH
authors.lastname: Sievers
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001018:Aortic Diseases / Q000188:drug therapy / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000592:standards; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000188:drug therapy* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D012648:Self Care / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants