Is the Ross procedure a riskier operation? Perioperative outcome comparison with mechanical aortic valve replacement in a propensity-matched cohort.
The aim of this study was to compare perioperative outcomes in young adults following isolated Ross procedure versus mechanical aortic valve replacement (AVR) in a high-volume centre.



From 2007 to 2015, 337 elective isolated mechanical AVRs and 137 Ross procedures were performed in young adults (<65 years) at our centre. Using a 1:1 propensity score match analysis, 140 patients were included in the study (n = 70 in each group). Perioperative outcomes were defined using STS guidelines. The primary outcome was operative mortality.



Median age was 52 [14] years and EuroSCORE II was 1.0 [0.4]%. There were no mortalities in the two groups. There were no differences in the incidence of myocardial injury (0% overall) and neurological complications (0.7% overall). Three (4%) reinterventions for bleeding were required in the Ross cohort versus six (9%) in the mechanical AVR cohort (P = 0.49). A significant increase in serum creatinine (>2-fold increase) was more commonly observed after the Ross procedure (11 vs 1%; P = 0.03), but there was no significant difference in the rate of temporary dialysis. Twenty-seven patients (39%) required ≥1 blood product transfusion in the Ross group, whereas 21 patients (31%) did so in the mechanical AVR group (P = 0.47). Median hospital length of stay was similar in both the groups (6 days).



There are no differences in mortality or major perioperative outcomes in adults undergoing an isolated Ross procedure or mechanical AVR.
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Ismail
I
Bouhout
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Pierre-Emmanuel
PE
Noly
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Aly
A
Ghoneim
Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montreal, Université de Montréal, Montreal, Canada.
Louis-Mathieu
LM
Stevens
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Raymond
R
Cartier
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Nancy
N
Poirier
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Denis
D
Bouchard
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Philippe
P
Demers
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada i.elhamamsy@icm-mhi.org.
Ismail
I
El-Hamamsy
D000293:Adolescent; D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001803:Blood Transfusion; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012189:Retrospective Studies; D055815:Young Adult
Aortic valve replacement; Mechanical aortic prosthesis; Propensity score; Ross procedure