Grant: Travel Awards - Institute Community Support

The treatment for aortic stenosis, the narrowing of the main heart valve, is difficult in young-middle aged patients (20-50 years of age. The diseased valve may be replaced with a mechanical valve, which requires the use of blood thinners for the lifetime of the patient. The use of blood thinners is associated with an increased risk of bleeding and stroke. The Ross Procedure is another option to replace the diseased valve whereby the patient's own pulmonary valve (termed "autograft" is moved to the aortic position, and a tissue cadaveric valve (termed homograft) is placed into the pulmonary position. The use of the patient's own pulmonary graft (i.e the autograft) removes the need for blood thinners. However, there are important limitations to the Ross procedure. First, the procedure is complex and the operative risk of death is double that of mechanical aortic valve replacement at many centres. Second, the autograft may fail with time, necessitating a higher risk reoperation in the future. These two important limitations have tempered enthusiasm for the Ross procedure. There is an important health policy question that must be addressed: what is an acceptable mortality rate for the Ross procedure when compared to the standard procedure of mechanical aortic valve replacement in the young-middle age population. To address this, a computer simulation model was created where hypothetical patients with this disease undergo either procedure and their life expectancy was compared. The computer simulation model found that when the operative mortality rate was less than 2.5%, the Ross procedure improved life expectancy of the patient as compared to the standard treatment of aortic valve replacement. These findings suggest that the Ross procedure should be performed at institutions that have a rate of death less than 2.5%.