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Propensity-Matched Comparison of the Ross Procedure and Prosthetic Aortic Valve Replacement in Adults

医学 心内膜炎 倾向得分匹配 相伴的 冲程(发动机) 累积发病率 主动脉瓣置换术 临床终点 人口 主动脉瓣 心脏病学 血液透析 罗斯手术 入射(几何) 内科学 外科 随机对照试验 移植 工程类 物理 狭窄 光学 环境卫生 机械工程
作者
Ismaı̈l El-Hamamsy,Nana Toyoda,Shinobu Itagaki,Paul Stelzer,Robin Varghese,Elbert E. Williams,Natalia Erogova,David H. Adams
出处
期刊:Journal of the American College of Cardiology [Elsevier]
卷期号:79 (8): 805-815 被引量:66
标识
DOI:10.1016/j.jacc.2021.11.057
摘要

There has recently been renewed interest in the Ross procedure in adults.The goal of this study was to compare long-term outcomes after the Ross procedure vs biological and mechanical aortic valve replacement (AVR) in adults (aged 18-50 years) undergoing aortic valve surgery.Mandatory California and New York databases were queried between 1997 and 2014. Exclusion criteria included: ≥1 concomitant procedure, reoperations, infective endocarditis, intravenous drug use, hemodialysis, and out-of-state residency. Propensity matching (1:1:1) was used, resulting in 434 patients per group. The primary endpoint was all-cause mortality. Secondary endpoints were stroke, major bleeding, reoperation, and endocarditis. Median follow-up was 12.5 years (IQR: 9.3-15.7 years).At 15 years, actuarial survival after the Ross procedure was 93.1% (95% CI: 89.1%-95.7%), similar to that of the age-, sex-, and race-matched U.S. general population. It was significantly lower after biological AVR (HR: 0.42; 95% CI: 0.23-0.075; P = 0.003) and mechanical AVR (HR: 0.45; 95% CI: 0.26-0.79; P = 0.006). At 15 years, the Ross procedure was associated with a lower cumulative risk of reintervention (P = 0.008) and endocarditis (P = 0.01) than biological AVR. In contrast, at 15 years, the Ross procedure was associated with a higher cumulative incidence of reoperation (P < 0.001) but lower risks of stroke (P = 0.03) and major bleeding (P = 0.016) than mechanical AVR. Thirty-day mortality after valve-related complications was lowest after a reintervention.In young adults, the Ross procedure is associated with better long-term survival and freedom from valve-related complications compared with prosthetic AVR. This confirms the notion that a living valve substitute in the aortic position translates into improved clinically relevant outcomes.
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