Aortic Valve Replacement With Ross Procedure Effective in Children and Young Adults

Aortic valve replacement (AVR) using the Ross procedure yielded positive results in children and young adults, according to data published in the Journal of the American College of Cardiology.

Although there are several options for AVR available in children and young adults, each has its uses and limitations. To compare the main types of AVR in children and young adults, researchers examined the early and long-term survival and freedom from reintervention in a national population of consecutive, unselected young patients.

The study included 1501 patients who underwent AVR in the United Kingdom between 2000 and 2012. In the total cohort, 47.8% underwent the Ross procedure, 37.8% had mechanical AVR, 10.9% had a bioprosthesis AVR, and 3.5% had homograft AVR. Researchers compared the procedures both in pairs and in a 3-way manner using a Bayesian dynamic survival model.

“The Ross procedure has multiple advantages that seem to extend beyond childhood, being superior to AVR types when compared in matched groups, especially in children, but all prostheses perform reasonably well overall,” they wrote.

The overall survival rate at 12 years was 94.6%. Among the different procedures, the survival rates varied, with 90.6% for mechanical AVR (n=567), 92.6% for bioprosthesis AVR (n=163), 93.4% for homograft AVR (n=53), and 97.3% for the Ross procedure (n=718).

Furthermore, children who had the Ross procedure had a 12.7% higher event-free probability from death or reintervention at 10 years when compared to mechanical AVR (P=.05).

Researchers also compared all procedures in a matched population of young adults, with the exception of the homograft AVR. Bioprosthesis AVR had the lowest event-free probability (78.8%), followed by mechanical AVR (86.3%), and the Ross procedure (89.6%).

Overall, younger age was associated with mortality and pulmonary reintervention in the Ross procedure cohort. Younger age was also associated with aortic reintervention in the mechanical AVR group.

The procedures were also compared to the survival of the general population, but the Ross procedure was the only method that had a similar survival pattern close to that of the general population.

“Although most methods of AVR in children and young adults are associated with good outcomes, the Ross procedure achieves better survival than other valve replacement options, but is associated with more frequent need for subsequent interventions,” the authors noted.

Longer follow-up studies are set to focus on the role of surgical balloon valvuloplasty in delaying AVR. Cost and quality of life analyses would also benefit patients by identifying the most advantageous valve substitutes.

Reference

Sharabiani MTA, Dorobantu DM, Mahani AS, et al. Aortic valve replacement and the Ross operation in children and young adults. J Am Coll Cardiol. 2016;67(24):2858-2870. doi: 10.1016/j.jacc.2016.04.021.