Department of Cardiac Surgery, Charles University, Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic.
Department of Cardiac Surgery, Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic.
Eur J Cardiothorac Surg. 2022 May 27;61(6):1357-1365. doi: 10.1093/ejcts/ezac013.
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. Our goal was to compare the strategies at a nationwide level.
This study was a retrospective analysis of prospectively recorded data from the National Registry of Cardiac Surgery of the Czech Republic. Using propensity score matching, we compared the outcomes of patients undergoing the Ross procedure in 2 dedicated centres with all mAVRs performed in country between 2009 and 2020.
Throughout the study period, 296 adults underwent the Ross procedure and 5120 had an mAVR. We found and compared 291 matched pairs. There were no in-hospital deaths, and the risk of perioperative complications was similar in both groups. Over the average follow-up period of 4.1 vs 6.1 years, the Ross group had a lower all-cause mortality (0.7 vs 6.5%; P = 0.015). This result remained significant even when accounting for cardiac- and valve-related deaths only (P = 0.048). Unlike the Ross group, the mAVR group had a significantly lower relative survival compared with the age- and sex-matched general population. There was no difference in the risk of reoperation (4.5 vs 5.5%; P = 0.66).
The Ross procedure offers a significant midterm survival benefit over mAVR. The procedures have a comparable risk of perioperative complications. Patients after mAVR have reduced survival. Thus, the Ross procedure should be the preferred treatment option for young and middle-aged adults with aortic valve disease in dedicated centres.
对于中青年主动脉瓣疾病患者，选择最佳的手术治疗方法仍然是一个挑战。尽管最近 Ross 手术的结果令人鼓舞，但机械主动脉瓣置换（mAVR）通常是首选。我们的目标是在全国范围内比较这两种策略。
这是一项对捷克共和国心脏外科国家注册处前瞻性记录数据的回顾性分析。我们使用倾向评分匹配，比较了 2009 年至 2020 年期间在 2 个专门中心接受 Ross 手术的患者与全国范围内所有接受 mAVR 的患者的结局。
在整个研究期间，有 296 名成年人接受了 Ross 手术，5120 人接受了 mAVR。我们找到了并比较了 291 对匹配患者。两组均无院内死亡，围手术期并发症风险相似。在平均 4.1 年与 6.1 年的随访期间，Ross 组的全因死亡率较低（0.7%比 6.5%；P=0.015）。当仅考虑与心脏和瓣膜相关的死亡时，这一结果仍然显著（P=0.048）。与 Ross 组不同，mAVR 组的相对生存率明显低于年龄和性别匹配的一般人群。再次手术的风险无差异（4.5%比 5.5%；P=0.66）。
与 mAVR 相比，Ross 手术在中期提供了显著的生存获益。这两种手术的围手术期并发症风险相当。接受 mAVR 的患者生存率降低。因此，在专门中心，对于中青年主动脉瓣疾病患者，Ross 手术应该是首选的治疗方法。
