Ross Procedure versus mechanical aortic valve replacement at 10 years? A prospective randomized trial

Objectives: The objective of this study was to compare long term performance of pulmonary autografts with mechanical aortic valves, in the treatment of aortic valve stenosis.

Methods: From September 1999 to August 2001, fourty patients with aortic valve stenosis, below the age of 55 years, were randomly assigned to receive either pulmonary autografts (n=20) or mechanical valves (Edwards MIRA; Edwards Lifesciences, Irvine, CA) prostheses (n=20). Clinical outcomes, left ventricular mass regression, effective orifice area, ejection fraction, and mean gradients were evaluated at yearly intervals. Follow-up was complete for all patients.

Results:

* p<0.05
	Ross	Mira
30 years mortality	n=0	n=0
1 year mortality	n=1	n=1
10 year mortality	n=2 (10%)	n=8 (40%) *
Valve related mortality	n=1	n=5
Bleeding event	n=0	n=5
Mean gradient (mmHg)	2.8±1.3	12±2.6 *
Effective Orifice Area (cm2)	2.6±0.4	1.7±0.6 *
Left ventricular mass index (g/m2)	112±26.1	120±33.5
Embolism	n=1	n=1

Conclusions: At 10 years, patients with pulmonary autografts showed a significantly better hemodynamic performance and less valve related complications than patients with mechanical prostheses, which was reflected by a better survival.