Ross Procedure May Provide Longer Survival Benefit

A rarely used valve replacement procedure could offer long-term benefits including longer survival, less clotting, and reduced bleeding complications compared to artificial implants, claims a new study.

Researchers at St. Michael’s Hospital (Toronto, Canada), the University of Toronto (UT; Canada), and other institutions conducted a meta-analysis that included randomized clinical trials and observational studies comparing the Ross procedure to a mechanical prosthesis in adults undergoing aortic valve replacement. In all, 18 studies that included 3,516 patients met inclusion criteria, with a median average follow-up of 5.8 years. The pre-specified outcomes were all-cause mortality and long-term outcomes.

The results revealed 46% lower all-cause mortality in those undergoing the Ross procedure, compared with mechanical aortic valves. In addition, patients who underwent the Ross procedure were 58% less likely to die from valve or heart related causes, suffered lower rates of stroke and major bleeding, and experienced a higher quality of life. Conversely, they were also 1.7 times more likely to require a second intervention, likely due to autograft respomse and the fact that two valves are involved, instead of one. The study was presented at the European Society of Cardiology (ESC) annual congress, held during August 2018 in Munich (Germany).

“Ensuring the best outcomes for patients involves tailoring the surgical approach to the patient,” said lead author cardiac surgeon Amine Mazine, MD, of St. Michael's Hospital. “Superior survival with the Ross procedure is likely due to the ability of a living graft to adapt, but this surgery is not for everyone; it needs to be the right patient undergoing the procedure to ensure the best outcomes.”

In the Ross procedure, a diseased aortic valve is replaced with the patient's own pulmonary valve, and pulmonary tissue from deceased donors is then used to replace the switched pulmonary valve. Its use has declined over the past 20 years due to its complexity, increased surgical risk, and potential risk of follow-up procedures. Mechanical valve replacement has also become more common, but patients must take anticoagulants for the rest of their lives to prevent valve clotting and strokes.

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