[Ross procedure versus mechanical aortic valve replacement in young adults].

Unlabelled: Clinical and echocardiographic data of young adults undergoing aortic valve replacement either by pulmonary autograft or mechanical prosthesis were analysed. Between 1995 and 2002 thirty-four consecutive patients (age 26.2 +/- 5.3 years) underwent aortic valve surgery by the authors (17 Ross procedures and 17 mechanical prostheses). Reasons for not doing a Ross procedure were size mismatch (3); anomalous coronaries (2); thin pulmonary sinuses (2); severe hypertension (2); poor LV function (2); active endocarditis (1); lack of suitable homograft (2) and the patient's request (3). There was no early mortality detected, although all patients were followed up (64.4 +/- 26.8 months). Two late deaths occurred in the prosthetic valve group (1 sepsis secondary to endocarditis, 1 end-stage heart failure). During the follow-up time there were two cases of endocarditis and two anticoagulant-related complications in the mechanical valve group. In the Ross group, one patient required reoperation for early endocarditis secondary to an infected homograft. The only late complication after the Ross procedure was a minor pulmonary embolism. Echocardiography showed a competent autograft in all but one patient. LV end diastolic dimensions and wall thickness were significantly smaller in the autograft patients (p = 0.049 andp = 0.017, respectively).

Conclusions: Freedom from anticoagulation-related complications and unrestricted lifestyle as well as the more complete LV mass regression make the autograft a superior valve substitute in young adults; however it is not suitable for everyone.