Document Detail


Survival comparison of the Ross procedure and mechanical valve replacement with optimal self-management anticoagulation therapy: propensity-matched cohort study.
MedLine Citation:
PMID:  21173349     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: It is suggested that in young adults the Ross procedure results in better late patient survival compared with mechanical prosthesis implantation. We performed a propensity score-matched study that assessed late survival in young adult patients after a Ross procedure versus that after mechanical aortic valve replacement with optimal self-management anticoagulation therapy.
METHODS AND RESULTS: We selected 918 Ross patients and 406 mechanical valve patients 18 to 60 years of age without dissection, aneurysm, or mitral valve replacement who survived an elective procedure (1994 to 2008). With the use of propensity score matching, late survival was compared between the 2 groups. Two hundred fifty-three patients with a mechanical valve (mean follow-up, 6.3 years) could be propensity matched to a Ross patient (mean follow-up, 5.1 years). Mean age of the matched cohort was 47.3 years in the Ross procedure group and 48.0 years in the mechanical valve group (P=0.17); the ratio of male to female patients was 3.2 in the Ross procedure group and 2.7 in the mechanical valve group (P=0.46). Linearized all-cause mortality rate was 0.53% per patient-year in the Ross procedure group compared with 0.30% per patient-year in the mechanical valve group (matched hazard ratio, 1.86; 95% confidence interval, 0.58 to 5.91; P=0.32). Late survival was comparable to that of the general German population.
CONCLUSIONS: In comparable patients, there is no late survival difference in the first postoperative decade between the Ross procedure and mechanical aortic valve implantation with optimal anticoagulation self-management. Survival in these selected young adult patients closely resembles that of the general population, possibly as a result of highly specialized anticoagulation self-management, better timing of surgery, and improved patient selection in recent years.
Authors:
M Mostafa Mokhles; Heinrich Körtke; Ulrich Stierle; Otto Wagner; Efstratios I Charitos; Ad J J C Bogers; Jan Gummert; Hans-Hinrich Sievers; Johanna J M Takkenberg
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-12-20
Journal Detail:
Title:  Circulation     Volume:  123     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-04     Completed Date:  2011-01-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  31-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery, Erasmus Medical Center, Room Bd 575, PO Box 2040, 3000 CA Rotterdam, the Netherlands. m.mokhles@erasmusmc.nl
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anticoagulants / therapeutic use*
Aortic Diseases / drug therapy,  surgery
Cardiac Surgical Procedures / standards
Cohort Studies
Female
Follow-Up Studies
Heart Valve Diseases / drug therapy*,  surgery*
Heart Valve Prosthesis Implantation / standards*
Humans
Male
Middle Aged
Propensity Score*
Prospective Studies
Registries
Self Care / standards*
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Anticoagulants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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