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Published on: April 1, 2022
The Ross procedure: a systematic review and meta-analysis.
Johanna J M Takkenberg1, Loes M A Klieverik, Paul H Schoof
1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Circulation
|January 2, 2009
Summary
The Ross procedure shows good outcomes for children and young adults, but durability issues emerge after ten years, especially in younger patients. This systematic review analyzes long-term results and determinants of the Ross procedure.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- The Ross procedure is a complex cardiac surgery with limited outcome data due to small study sizes.
- Variable durability results necessitate a comprehensive review to understand long-term efficacy.
- Identifying determinants of outcome is crucial for optimizing patient selection and surgical technique.
Purpose of the Study:
- To systematically review and synthesize evidence on the outcomes of the Ross procedure.
- To assess the pooled morbidity and mortality rates associated with the procedure.
- To investigate the durability of autografts and right ventricular outflow tract conduits, and identify factors influencing them.
Main Methods:
- A systematic review of 39 articles published between January 2000 and January 2008.
- Articles categorized into consecutive, adult, and pediatric patient series.
- Pooled analysis using an inverse variance approach to determine morbidity, mortality, and deterioration rates.
Main Results:
- Pooled early mortality rates were 3.0% for consecutive, 3.2% for adult, and 4.2% for pediatric series.
- Autograft deterioration rates ranged from 0.78% to 1.38%/patient-year, and right ventricular outflow tract conduit deterioration from 0.55% to 1.60%/patient-year.
- Deterioration rates were higher in younger patients (< or =18 years) compared to older patients (>18 years).
Conclusions:
- The Ross procedure demonstrates satisfactory outcomes in both pediatric and adult populations.
- Durability limitations are observed by the end of the first postoperative decade.
- Younger patients undergoing the Ross procedure may experience earlier signs of autograft or conduit deterioration.