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Ross Operation in Neonates: A Meta-analysis.

Taufiek Konrad Rajab1, Andres Zorrilla-Vaca2, Minoo Naozer Kavarana1

  • 1Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.

The Annals of Thoracic Surgery
|December 4, 2020
PubMed
Summary

The Ross operation for neonatal aortic valve replacement has a high early mortality rate of 24%. This highlights the ongoing challenge in treating neonates with unrepairable aortic valves in congenital cardiac surgery.

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Area of Science:

  • Pediatric Cardiac Surgery
  • Thoracic Surgery
  • Congenital Heart Disease

Background:

  • The Ross operation is a preferred aortic valve replacement technique in children.
  • Previous research suggests suboptimal outcomes for the Ross operation in neonates.
  • This meta-analysis specifically investigates the pooled outcomes of the Ross operation in this vulnerable population.

Purpose of the Study:

  • To evaluate the pooled early and late mortality rates associated with the Ross operation in neonates.
  • To assess the incidence of mechanical support post-operation in neonatal Ross procedures.
  • To identify trends in outcomes over time for neonatal Ross operations.

Main Methods:

  • A comprehensive literature search was conducted across PubMed/MEDLINE, EMBASE, Scopus, and ScienceDirect databases until May 1, 2020.
  • Included studies reported outcomes for the Ross operation in neonates, with early mortality as the primary outcome.
  • Random-effects models and continuity corrections were employed to analyze data from 18 studies involving 181 neonates.

Main Results:

  • The pooled early mortality rate for the neonatal Ross operation was 24% (95% CI, 12%-38%).
  • Meta-regression indicated that more recent studies reported significantly worse early mortality.
  • The pooled incidence of postoperative mechanical support was 15% (95% CI, 5%-28%).

Conclusions:

  • The neonatal Ross operation is associated with a high early mortality rate.
  • Effective treatment strategies for neonates with unrepairable aortic valves remain a significant challenge in congenital cardiac surgery.
  • Further research is needed to improve outcomes for this patient group.