Martin Andreas1, Dominik Wiedemann2, Gernot Seebacher2, Claus Rath2, Tandis Aref2, Raphael Rosenhek3, Georg Heinze4, Ernst Eigenbauer4, Paul Simon2, Kurt Ruetzler5, Joerg-Michael Hiesmayr5, Anton Moritz6, Guenther Laufer2, Alfred Kocher2. 1. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria martin.andreas@meduniwien.ac.at. 2. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. 3. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria. 4. Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria. 5. Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria. 6. Department of Thoracic, Cardiac and Thoracovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
Abstract
OBJECTIVES: 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.
OBJECTIVES: 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.
Authors: Amine Mazine; Rodolfo V Rocha; Ismail El-Hamamsy; Maral Ouzounian; Bobby Yanagawa; Deepak L Bhatt; Subodh Verma; Jan O Friedrich Journal: JAMA Cardiol Date: 2018-10-01 Impact factor: 14.676
Authors: Martin Andreas; Stephanie Wallner; Andreas Habertheuer; Claus Rath; Martin Schauperl; Thomas Binder; Dietrich Beitzke; Raphael Rosenhek; Christian Loewe; Dominik Wiedemann; Alfred Kocher; Guenther Laufer Journal: Interact Cardiovasc Thorac Surg Date: 2016-03-13