The Ross procedure offers excellent survival compared with mechanical aortic valve replacement in a real-world setting.
OBJECTIVE
The ideal prosthesis for young patients requiring aortic valve replacement has not been defined to date. Although the Ross procedure provides excellent survival, its application is still limited. We compared the long-term survival after the Ross procedure with mechanical aortic valve replacement.


METHODS
All consecutive Ross procedures and mechanical aortic valve replacements performed between 1991 and 2008 at a single centre were analysed. Only adult patients between 18 and 50 years of age were included in the study. Survival and valve-related complications were evaluated. Furthermore, survival was compared with the age- and sex-matched Austrian population.


RESULTS
A total of 159 Ross patients and 173 mechanical valve patients were included. The cumulative survival for the Ross procedure was significantly better, with survival rates of 96, 94 and 93% at 5, 10 and 15 years, respectively, in comparison to 90, 84 and 75% (P < 0.01) for patients with mechanical valves. A Cox regression analysis including patients' age, gender and valve type revealed age and the type of aortic valve replacement as independent significant factors influencing survival (for age, hazard ratio = 1.1, 95% confidence interval = 1.0-1.1, P = 0.03; and for valve type, hazard ratio = 2.6, 95% confidence interval = 1.2-5.8, P = 0.02). The observed survival was comparable to the expected standard survival for the Ross group but was significantly reduced in the mechanical valve group.


CONCLUSIONS
In a real-world setting, the Ross procedure is associated with a long-term survival benefit in young adults in comparison to mechanical aortic valve replacement.
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria martin.andreas@meduniwien.ac.at.
Martin
M
Andreas
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Dominik
D
Wiedemann
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Gernot
G
Seebacher
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Claus
C
Rath
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Tandis
T
Aref
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Raphael
R
Rosenhek
Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Georg
G
Heinze
Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Ernst
E
Eigenbauer
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Paul
P
Simon
Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria.
Kurt
K
Ruetzler
Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria.
Joerg-Michael
JM
Hiesmayr
Department of Thoracic, Cardiac and Thoracovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
Anton
A
Moritz
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Guenther
G
Laufer
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Alfred
A
Kocher
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
Aortic valve replacement; Mechanical valve; Outcome (survival, reoperation); Pulmonary autograft; Ross operation