Aortic Valve Replacement in Middle-Age Adults: Biological Prosthesis versus Ross Procedure

Background: Although guidelines suggested alternative for aortic valve replacement in middle-age adults under 60 years of age is actually mechanical prosthesis, increasingly more patients receive a biological prosthesis. However, the Ross procedure is also an option in this population. How justifiable is this practice?

Methods: Single center propensity score matched (PSM) comparison of the long-term outcomes after biological aortic valve replacement (bioAVR) or the Ross procedure (Ross) in adults. This study includes 2622 patients operated between April 2007 and March 2020. Out of these, 2391 received bioAVR and 231 received the Ross procedure, with or without concomitant CABG or aortic surgery. Exclusion criteria are emergency surgery and concomitant mitral or tricuspid valve surgery. Using 1:1 propensity score 99 patients were matched. Primary end-point is all-cause mortality. Secondary end-point is MACE: composite of death, need for repeat intervention, and stroke. Active cross-sectional follow-up was median 7.5 years (IQR: 4.4–10.6 years).

Results: BioAVR patients were 56.2 ± 5.9 years old, and the Ross patients were 56.2 ± 6.1 years. Aortic valve pathology (stenosis and regurgitation) as well as prevalence of BAV was comparable between the groups. Actuarial 10-year survival for the bio AVR patients was 57.9%, while it was significantly better for the Ross patients with 89.3% (p < 0.001). The MACE-free survival was also significantly better after the Ross procedure compared with bio AVR (log rank p < 0.001).

Conclusion: After 10 years of follow-up, the conventional bio AVR in middle-aged adults undergoing AVR was inferior to the Ross procedure. Hence, the Ross procedure should be advocated in this population every time feasible.

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Artikel online veröffentlicht:
13. Februar 2024