Abstract 14923: Is the Ross Procedure a Riskier Operation? - Perioperative Outcome Comparison With Mechanical Aortic Valve Replacement in a Propensity-Matched Cohort

Abstract

Introduction: Despite reports of improved long-term survival after the Ross procedure, concerns remain regarding increased surgical complexity and potential morbidity compared to standard aortic valve replacement (AVR). Hypothesis: The aim of this study was to compare perioperative outcomes in young adults following a Ross procedure versus mechanical AVR in the current era. Patients and methods: From 2007 to 2015, 337 elective isolated mechanical AVRs and 137 Ross procedures were performed in young adults (<65 years) at our center. The Ross cohort includes the learning curve. Patients with concomitant ascending aorta replacement were included (78 (57%) in the Ross group and 58 (17%) in the AVR group). Using a 1:1 propensity score match analysis, 164 patients were included in the study (n=82 in each group). Mean age was 48±11 years and Euroscore II was 1.1±0.6%. Perioperative outcomes were defined using STS guidelines. Results: There were no mortalities in the two groups. Mean cardiopulmonary bypass and crossclamp times were longer in the Ross cohort (210+/-28 and 185+/-24 min vs 82+/-29 and 62+/-21 min respectively; p< 0.001). There were no differences in the incidence of myocardial injury (0% overall), neurological complications (0.6% overall) or intubation times (p=NS). Three (3.7%) reinterventions for bleeding were reported in the Ross cohort and 4 (4.9%) in the mechanical AVR cohort (p>0.99). A significant increase in serum creatinine (>2-fold increase) was more commonly observed after the Ross procedure (11% versus 0%; p=0. 003), but there was no significant difference in the rate of temporary dialysis (p=0.25). Six of 9 patients (67%) with increased creatine levels occurred in the first tertile of the Ross cohort. Thirty patients (37%) required ≥1 blood product transfusion in the Ross group compared to 26 patients (32%) in the mechanical AVR group (p=0.5). Median hospital length of stay was similar in both groups (6 days in each; p=0.99). Conclusion: There are no differences in mortality or major perioperative outcomes in adults undergoing a Ross procedure or mechanical AVR. Acute renal injury in the Ross cohort was closely linked to the learning curve. Further follow-up is required to evaluate long-term outcomes in these cohorts.