ross for valve replacement in adults trial

Conditions: Aortic Valve Disease

Summary: this study evaluates two methods of aortic heart valve replacement in adults aged 18-60, the ross procedure versus conventional aortic valve replacement using a biologic or mechanical heart valve. the ross procedure replaces a patient's diseased aortic valve with his/her own pulmonary valve and uses a donor valve in the pulmonary position which receives less stress than the aortic valve. mechanical valves tend to form blood clots so they need long-term blood thinners that increase risk of bleeding and lower quality of life. animal tissue valves reduce clotting and bleeding risks but wear out sooner and shorten patient life-span.

heart valves help control blood flow through the heart and, if diseased, may need to be replaced. after having a heart valve replaced, patients have a higher risk of death than people who have not had a valve replaced. in young adult patients, replacing the aortic heart valve with a mechanical valve halves their life-span compared to other people their age. mechanical valves tend to form blood clots so they need long-term blood thinners that increase risk of bleeding and lower quality of life. animal tissue valves reduce clotting and bleeding risks but wear out sooner and shorten patient life-span. an operation, called the ross procedure, replaces a patient's diseased aortic valve with his/her own pulmonary valve and uses a donor valve in the pulmonary position which receives less stress than the aortic valve. the ross procedure aims to improve valve durability with less clotting, avoiding use of blood thinners. patients and physicians need a large, high-quality study comparing the ross procedure and standard valve replacement to know if either approach is better. the investigators will perform a 3-year feasibility study in seven sites, in canada and abroad, to test the study design and ability to do a larger, conclusive study comparing the impact of the ross procedure to standard valve replacement on survival without valve-related life-threatening complications. patients will be randomized, like flipping a coin, to receive the ross or standard valve surgery. the goals are 1) to evaluate if the investigators can recruit 6 patients per site per year, 2) to test if the assigned procedure is performed in over 90% of study patients, and 3) to see how many mechanical vs. tissue valves are used in the standard valve group. patients eligible but not enrolled in the trial will be asked if the investigators can collect some data on how they do after their surgery. if the investigators show the study is feasible, they will proceed to the full study and will include the feasibility patients in the full study.

Eligibility criteria:
inclusion criteria: 1. age 18-60 years 2. undergoing clinically indicated aortic valve replacement 3. provided written informed consent exclusion criteria: 1. previous valve replacement not in the aortic position 2. patients undergoing concomitant cabg or other valve procedure during aortic valve replacement 3. known connective tissue disease 4. severe (grade 3 or 4) right or left ventricular dysfunction 5. pulmonary valve dysfunction or anomaly not compatible with the ross procedure (as determined by the consulting cardiac surgeon) 6. life expectancy less than 5 years (as determined by the consulting cardiac surgeon) 7. documented severe aortic insufficiency not solely due to leaflet issue 8. previous intervention on the pulmonary valve

Keywords: cardiac surgery aortic valve replacement ross procedure