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Long-Term Results of the Ross Operation versus Mechanical Aortic Valve Replacement: a Propensity-Score Matched Analysis
Stefano Mastrobuoni, Lurent De Kerchove, Silvia Solari, Alain Poncelet, Parla Astarci, Robert Verhelst, Philippe Noirhomme, Jean Rubay, Gebrine El Khoury.
Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium.

Objective: The pulmonary autograft (Ross Procedure) offers some advantages compared to bio-prostheses in young adult patients (<60 years of age) who need aortic valve replacement (AVR), but it is unknown whether it is superior to mechanical AVR in this cohort. Aim of this study was to compare the long-term outcome of the Ross procedure compared to mechanical AVR in a propensity-score matched cohort of young adult patients.
Methods. Between 1991 and 2013, 324 consecutive adult patients underwent elective aortic valve replacement with the Ross operation while 544 had mechanical AVR at Our Institution. Patients were matched by means of the Propensity Score (PS). Survival and long-term freedom from complications were compared in the matched cohort.
Results. Ninety Ross patients were PS-matched to a mechanical AVR patient. Mean age was 51.3 years in the M-AVR and 45.5 years in the Ross group (p<0.01). Freedom from bleeding/thromboembolism at 10 years postoperatively was 80+5.4% and 92.7+3.2% in the M-AVR and Ross group respectively (p=0.09). Freedom from valve reoperation was 98.8+1.2% and 86.1+4.7% in the two groups respectively (p=0.01). Survival at 10 years was significantly better in the Ross group (94.7+2.6% vs 70.3+5.7%, p=0.001).
Conclusions. The Ross operation has shown a higher risk of reoperation in the long-term compared to mechanical AVR and a similar risk of bleeding/thromboembolic complications. Nevertheless the long-term survival of Ross patients is significantly better than the M-AVR peers.

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