ROSS PROCEDURE PROVIDES SURVIVAL BENEFIT OVER MECHANICAL VALVE IN ADULTS: A PROPENSITY-MATCHED NATIONWIDE ANALYSIS

Objectives
The choice of optimal surgical treatment for young and middle-aged adults with aortic valve disease remains a challenge. Mechanical aortic valve replacement (mAVR) is generally preferred despite promising recent outcomes of the Ross procedure. We aimed to compare both strategies at a nationwide level.

Methods
This was a retrospective analysis of prospectively recorded data from the National Registry of Cardiac Surgery. Using propensity-score matching, we compared the outcomes of patients undergoing the Ross procedure in two dedicated centers with all mAVRs performed in the Czech Republic between 2009 and 2020.

Results
Throughout the study period, 296 adults underwent the Ross procedure and 5 120 had a mAVR. We found and compared 291 matched pairs. There was no in-hospital mortality and the risk of perioperative complications was similar in both groups. Over the average follow-up of 4.1 vs 6.1 years, the Ross group had a lower all-cause mortality (0.7 vs 6.5 %; p = 0.015). Unlike the Ross group, the mAVR group had significantly lower relative survival when compared with the age- and sex-matched general population at 10 years postoperatively (97.1 %, CI 86.8-108.7 vs 93.5 %, CI 88.1-99.2). There was no difference in the risk of reoperation (4.5 vs 5.5 %; p = 0.66).

Conclusions
The Ross procedure offers a significant mid-term survival benefit over mAVR. Both procedures have a comparable risk of perioperative complications. For young and middle-aged adults with aortic valve disease, Ross procedure should be considered a procedure of choice in dedicated centers.