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The Ross Procedure: A Systematic Review, Meta-Analysis, and Microsimulation.

Jonathan R G Etnel¹, Pepijn Grashuis¹, Simone A Huygens^1,2

¹Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands (J.R.G.E., P.G., S.A.H., B.P., G.P., A.J.J.C.B., M.M.M., J.J.M.T.).

Circulation. Cardiovascular Quality and Outcomes

|December 19, 2018

Summary

This summary is machine-generated.

The Ross procedure offers excellent survival and avoids anticoagulation for aortic valve replacement. However, most patients will require reintervention later in life.

Keywords:

aortic valve replacement clinical outcome meta-analysis microsimulation pulmonary autograft the Ross procedure

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Area of Science:

Cardiovascular Surgery
Pediatric Cardiology
Thoracic Surgery

Background:

The Ross procedure is a surgical option for aortic valve replacement in children and adults.
Decision-making for aortic valve replacement requires a comprehensive understanding of procedure outcomes.

Purpose of the Study:

To provide an overview of outcomes following the Ross procedure.
To support clinical decision-making for aortic valve replacement.

Main Methods:

Systematic literature search for publications between 2000 and 2017.
Pooled analysis of event rates and time-to-event data.
Microsimulation modeling to estimate life expectancy and lifetime event risk.

Main Results:

Included 99 publications with 13,129 patients.
Pooled early mortality: 4.19% in children, 2.01% in adults.
High lifetime reintervention risk: 94% for autograft and 100% for RVOT in children; 49% for autograft and 19% for RVOT in adults.
Estimated life expectancy: 59 years for children, 30 years for 45-year-olds.

Conclusions:

The Ross procedure offers excellent survival and avoids anticoagulation.
It is a unique option for patients unsuitable for mechanical valves and for growing children.
A significant drawback is the high likelihood of future reintervention for most patients.