Improved Outcomes Following the Ross Procedure Compared With Bioprosthetic Aortic Valve Replacement

Mazine, Amine; David, Tirone E.; Stoklosa, Klaudiusz; Chung, Jennifer; Lafrenière-Roula, Myriam; Ouzounian, Maral

doi:10.1016/j.jacc.2021.12.026

Cited by 38 publications

(23 citation statements)

References 37 publications

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“…In addition, 21 articles were excluded with the following reasons: n=10: no comparison or control groups; n=4: neither randomized nor PSM; n=3: pediatric patients aged <16 years; n=2: review article; n=1: no outcomes of interest reported; and n=1: trial protocol. Ten articles met the inclusion criteria and were assessed for the systematic review and the meta‐analysis 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 29 (Figure S1 ). Of those, 2 were RCTs 10 , 29 and 8 were PSM studies, 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 which enrolled a total of 4812 patients who received the Ross procedure (n=1991), M‐AVR (n=2019), or B‐AVR (n=802).…”

Section: Resultsmentioning

confidence: 99%

“…Ten articles met the inclusion criteria and were assessed for the systematic review and the meta‐analysis 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 29 (Figure S1 ). Of those, 2 were RCTs 10 , 29 and 8 were PSM studies, 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 which enrolled a total of 4812 patients who received the Ross procedure (n=1991), M‐AVR (n=2019), or B‐AVR (n=802).…”

Section: Resultsmentioning

confidence: 99%

“…Several long‐term observational studies of the Ross procedure, some of which contain series of contemporary modifications of surgical techniques, have shown favorable results. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 Despite the large body of cumulative evidence demonstrating restored survival after the Ross procedure, the recognition of the Ross procedure in our community remains sparse. In the 2020 American College of Cardiology/American Heart Association valve guidelines, there is a class IIb recommendation for use of the Ross procedure in patients aged <50 years, 19 whereas there is no description of the Ross procedure in the 2021 European guidelines.…”

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confidence: 99%

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Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis

Yokoyama

Kuno

Toyoda

et al. 2023

JAHA

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Background The Ross operation appears to restore normal survival in young and middle‐aged adults with aortic valve disease. However, there are limited data comparing it with conventional aortic valve replacement. Herein, we compared outcomes of the Ross procedure with mechanical and bioprosthetic aortic valve replacement (M‐AVR and B‐AVR, respectively). Methods and Results MEDLINE and EMBASE were searched through March 2022 to identify randomized controlled trials and propensity score–matched studies that investigated outcomes of patients aged ≥16 years undergoing the Ross procedure, M‐AVR, or B‐AVR. The systematic literature search identified 2 randomized controlled trials and 8 propensity score–matched studies involving a total of 4812 patients (Ross: n=1991; M‐AVR: n=2019; and B‐AVR: n=802). All‐cause mortality was significantly lower in the Ross procedure group compared with M‐AVR (hazard ratio [HR] [95% CI], 0.58 [0.35–0.97]; P =0.035) and B‐AVR (HR [95% CI], 0.32 [0.18–0.59]; P <0.001) groups. The reintervention rate was lower after the Ross procedure and M‐AVR compared with B‐AVR, whereas it was higher after the Ross procedure compared with M‐AVR. Major bleeding rate was lower after the Ross procedure compared with M‐AVR. Long‐term stroke rate was lower following the Ross procedure compared with M‐AVR and B‐AVR. The rate of endocarditis was also lower after the Ross procedure compared with B‐AVR. Conclusions Improved long‐term outcomes of the Ross procedure are demonstrated compared with conventional M‐AVR and B‐AVR options. These results highlight a need to enhance the recognition of the Ross procedure and revisit current guidelines on the optimal valve substitute for young and middle‐aged patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis

Yokoyama

Kuno

Toyoda

et al. 2023

JAHA

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“…Finally, the other was one case of a child who had severe myocardial ischemia; a Ross procedure was performed and the right ventricular outflow tract was reconstructed using a handmade valved polytetrafluoroethylene tube 4 . This procedure (Ross) could have been an option in our patient, recent studies show good results in the medium‐long term, however, in our center we do not have experience with this technique, that is why we opted for an AV reconstruction surgery in view that the patient rejected a mechanical prosthesis 5 …”

Section: Discussionmentioning

confidence: 97%

“…4 This procedure (Ross) could have been medium-long term, however, in our center we do not have experience with this technique, that is why we opted for an AV reconstruction surgery in view that the patient rejected a mechanical prosthesis. 5 Some authors suggest that an attached AV leaflet could be sequelae of an infectious process affecting the aorta and/or the aortic valve. However, previous reports have found no evidence of any history of rheumatic disease, syphilis, or any other infectious diseases.…”

Section: Discussionmentioning

confidence: 99%

Attached right aortic valve leaflet causing ischemia and severe regurgitation: Successful repair with Ozaki technique

Ríos-Ortega¹,

Rodríguez-Urteaga²,

Carrasco-Rueda³

et al. 2022

Journal of Cardiac Surgery

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Introduction: Coronary artery occlusion due to fusion of a leaflet to the sinotubular junction is a rare finding that we should consider in the differential diagnosis of young patients who have aortic regurgitation and angina. Patient and Method: We present a young female with severe aortic regurgitation due to right coronary fusion who underwent mini-invasive aortic valve reconstruction. Results: Postoperative evolution was satisfactory. The patient was discharged on the 5th postoperative day and after 3.5 years of follow-up he remains in functional class I, without anticoagulant treatment and with mild aortic regurgitation. Cocnclusion: The Ozaki technique can be used in patients with aortic regurgitation due to single leaflet dysfunction.

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Management Challenges in Patients Younger Than 65 Years With Severe Aortic Valve Disease

et al. 2023

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ImportanceThe management of aortic valve disease, including aortic stenosis and aortic regurgitation (AR), in younger adult patients (age &lt;65 years) is complex, and the optimal strategy is often unclear, contingent on multiple anatomic and holistic factors.ObservationsTraditional surgical approaches carry significant considerations, including compulsory lifelong anticoagulation for patients who receive a mechanical aortic valve replacement (AVR) and the risk of structural valvular deterioration and need for subsequent valve intervention in those who receive a bioprosthetic AVR. These factors are magnified in young adults who are considering pregnancy, for whom issues of anticoagulation and valve longevity are heightened. The Ross procedure has emerged as a promising alternative; however, its adoption is limited to highly specialized centers. Valve repair is an option for selected patients with AR. These treatment options offer varying degrees of durability and are associated with different risks and complications, especially for younger adult patients. Patient-centered care from a multidisciplinary valve team allows for discussion of the optimal timing of intervention and the advantages and disadvantages of the various treatment options.Conclusions and RelevanceThe management of severe aortic valve disease in adults younger than 65 years is complex, and there are numerous considerations with each management decision. While mechanical AVR and bioprosthetic AVR have historically been the standards of care, other options are emerging for selected patients but are not yet generalizable beyond specialized surgical centers. A detailed discussion by members of the multidisciplinary heart team and the patient is an integral part of the shared decision-making process.

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Improved Outcomes Following the Ross Procedure Compared With Bioprosthetic Aortic Valve Replacement

Cited by 38 publications

References 37 publications

Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis

Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis

Attached right aortic valve leaflet causing ischemia and severe regurgitation: Successful repair with Ozaki technique

Management Challenges in Patients Younger Than 65 Years With Severe Aortic Valve Disease

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