27 Aug Using a Pulmonary Valve To Replace Diseased Aortic Valve Improves QoL and Survival in Young and Middle-age Adults
MedicalResearch.com Interview with:
Dr. Mazine
Amine Mazine, MD, MSc
Associate Editor, BMC Surgery
PGY-4 Cardiac Surgery
PhD Candidate, Institute of Biomaterials and Biomedical Engineering
McEwen Center for Regenerative Medicine
Surgeon-Scientist Training Program
University of Toronto
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We performed this study to compare two methods of replacing a diseased aortic valve in young and middle-aged adults: using an artificial mechanical valve (mechanical aortic valve replacement) versus using the patient’s own pulmonary valve (Ross procedure).
The study was a meta-analysis of existing literature that included more than 3,500 adult patients. It found that those who underwent the Ross procedure were 46 per cent less likely to experience death from any cause than patients who underwent mechanical aortic valve replacement. Patients in the Ross group were also less likely to suffer from a stroke or major bleeding, and had better quality of life. Patients who underwent the Ross procedure were more likely to need late reoperation, but this did not negatively impact their survival.
MedicalResearch.com: What should readers take away from your report?
Response: There is now ample evidence of the superiority of the Ross procedure over mechanical aortic valve replacement in young and middle-aged adults undergoing aortic valve replacement. Thus, the Ross procedure can no longer be ignored or considered a “niche procedure”. Rather, it should be offered as an option for all young adults undergoing aortic valve replacement who do not have a contraindication to the operation.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Centers that perform the Ross operation should continue to closely monitor their long-term outcomes. When dealing with young and middle-aged adults, one must keep in mind their long life expectancy. Thus far, results of the Ross operation have been encouraging up to 25 years after surgery. More studies with rigorous long-term follow-up will only serve to cement the Ross procedure as the operation of choice for young and middle-age adults undergoing AVR who don’t have any contra-indications.
MedicalResearch.com: Is there anything else you would like to add?
Response: We would like to highlight that today, for young and middle-aged patients undergoing aortic valve replacement, the paradigm has changed from the standard “anticoagulation versus reoperation” dilemma (when choosing between mechanical or biological prostheses), to a more fundamental one of “long-term survival and quality of life”. There is currently enough evidence to suggest that although the rate of late reoperation with a Ross procedure may be higher, these patients live longer, better and healthier lives than with prosthetic AVR.
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Last Updated on August 27, 2018 by Marie Benz MD FAAD