Aortic Valve Replacement and the Ross Operation in Children and Young Adults.
BACKGROUND
There are several options available for aortic valve replacement (AVR), with few comparative reports in the literature. The optimal choice for AVR in each age group is not clear.


OBJECTIVE
The study sought to report and compare outcomes after AVR in the young using data from a national database.


METHODS
AVR procedures were compared after advanced matching, both in pairs and in a 3-way manner, using a Bayesian dynamic survival model.


RESULTS
A total of 1,501 patients who underwent AVR in the United Kingdom between 2000 and 2012 were included. Of these, 47.8% had a Ross procedure, 37.8% a mechanical AVR, 10.9% a bioprosthesis AVR, and 3.5% a homograft AVR, with Ross patients being significantly younger when compared to the other groups. Overall survival at 12 years was 94.6%. In children, the Ross procedure had a 12.7% higher event-free probability (death or any reintervention) at 10 years when compared to mechanical AVR (p = 0.05). We also compared all procedures except the homograft in a matched population of young adults, where the bioprosthesis had the lowest event-free probability of 78.8%, followed by comparable results in mechanical AVR and Ross, with 86.3% and 89.6%, respectively. Younger age was associated with mortality and pulmonary reintervention in the Ross group and with aortic reintervention in the mechanical AVR. Of all 3 options, only the patients undergoing the Ross procedure approached the survival of the general population.


CONCLUSIONS
AVR in the young achieves good results, with the Ross being overall better suited for this age group, especially in children. Although freedom from aortic valve reintervention is superior after the Ross procedure, the need for homograft reinterventions is an issue to take into account. All methods have advantages and limitations, with reinterventions being an issue in the long term for all, more crucially in smaller children.
Department of Cardiothoracic Surgery, Imperial College, London, United Kingdom.
Mansour T A
MT
Sharabiani
Department of Cardiothoracic Surgery, University Hospitals Bristol NHS Trust, Bristol, United Kingdom; Cardiology Department, "Prof. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania. Electronic address: dn.dorobantu@gmail.com.
Dan M
DM
Dorobantu
Sentrana Inc., Washington, DC.
Alireza S
AS
Mahani
Department of Cardiothoracic Surgery, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
Mark
M
Turner
Department of Cardiothoracic Surgery, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
Andrew J
AJ
Peter Tometzki
Department of Cardiothoracic Surgery, Imperial College, London, United Kingdom; Department of Cardiothoracic Surgery, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
Gianni D
GD
Angelini
Department of Cardiothoracic Surgery, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
Andrew J
AJ
Parry
Department of Cardiothoracic Surgery, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
Massimo
M
Caputo
Department of Cardiothoracic Surgery, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
Serban C
SC
Stoica
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015233:Models, Statistical; D012086:Reoperation / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
Ross procedure; aortic valve disease; aortic valve replacement; congenital heart disease