BACKGROUND:The ideal aortic valve substitute in young and middle-aged adults remains unknown. We sought to compare the long-term outcomes of patients undergoing the Ross procedure and those receiving a mechanical aortic valve replacement (AVR). METHODS:From 1990 to 2014, 258 patients underwent a Ross procedure and 1444 had a mechanical AVR at a single institution. Patients were matched into 208 pairs through the use of a propensity score. Mean age was 37.2±10.2 years, and 63% were male. Mean follow-up was 14.2±6.5 years. RESULTS:Overall survival was equivalent (Ross versus AVR: hazard ratio, 0.91, 95% confidence interval, 0.38-2.16; P=0.83), although freedom from cardiac-and valve-related mortality was improved in the Ross group (Ross versus AVR: hazard ratio, 0.22; 95% confidence interval, 0.034-0.86; P=0.03). Freedom from reintervention was equivalent after both procedures (Ross versus AVR: hazard ratio, 1.86; 95% confidence interval, 0. 76-4.94; P=0.18). Long-term freedom from stroke or major bleeding was superior after the Ross procedure (Ross versus AVR: hazard ratio, 0.09; 95% confidence interval, 0.02-0.31; P<0.001).CONCLUSIONS: Long-term survival and freedom from reintervention were comparable between the Ross procedure and mechanical AVR. However, the Ross procedure was associated with improved freedom from cardiacand valve-related mortality and a significant reduction in the incidence of stroke and major bleeding. In specialized centers, the Ross procedure represents an excellent option and should be considered for young and middle-aged adults undergoing AVR. long-term Outcomes of the ross Procedure Versus Mechanical aortic Valve replacementPropensity-Matched cohort study © 2016 American Heart Association, Inc.Key Words: aortic valve ◼ propensity score ◼ surgery ◼ treatment outcome ORIGINAL RESEARCH ARTICLE 577 Y oung and middle-aged adults with diseased aortic valves constitute a challenging population. Because of their longer anticipated life expectancy, these patients present a higher cumulative lifetime risk of prosthesis-related complications. The ideal aortic valve substitute in this patient population should allow improved survival, avoidance of reoperation and prosthesis-related complications, and maintenance of an active lifestyle with a good quality of life.As a result of their proven durability and ease of implantation, mechanical prostheses have long been the most frequently used option for aortic valve replacement (AVR) in young and middle-aged adults. However, recent reports suggest an excess in long-term mortality in young patients who undergo mechanical AVR compared with the age-and sex-matched general population.1,2 In addition, for female patients of childbearing age, mechanical prostheses are associated with an increased risk of thromboembolic events and warfarin-associated fetal malformations. 3,4 The Ross procedure (pulmonary autograft replacement) alleviates the need for lifelong anticoagulation. It allows the replacement of the diseased aortic valve with a living substitute, 5 th...

Mid-term imaging after aortic valve and ascending aorta replacement indicates that if the aortic root is not dilated at the time of surgery, the risk of enlargement over time is minimal, negating the need for prophylactic root replacement in patients with BAV or TAV.