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The Ross Procedure in Children and Infants: A Systematic Review With Pooled Analyses.
Nabil Dib1,2, Walid Ben Ali1, Thierry Ducruet3
1Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
CJC Pediatric and Congenital Heart Disease
|July 29, 2024
Summary
The Ross procedure offers modest survival rates in children with congenital aortic stenosis. However, infants undergoing this surgery face significantly higher mortality and reintervention risks, highlighting the need for careful consideration.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Aortic Valve Replacement
Background:
- The Ross procedure is a surgical option for congenital aortic stenosis, replacing the aortic valve with a pulmonary autograft.
- Outcomes in children, especially infants, following the Ross procedure are not well-established.
Purpose of the Study:
- To systematically review and analyze survival and reintervention rates after the Ross procedure in children.
- To specifically evaluate outcomes in infants (younger than 1 year) compared to older children.
Main Methods:
- Systematic review and pooled analysis of 25 studies including 2737 patients, adhering to PRISMA criteria.
- Extraction of inferred individual patient data from life tables to assess primary endpoints: early (≤30 days) and late (>30 days) mortality.
- Secondary endpoints included freedom from reintervention for the right ventricular outflow tract and pulmonary autograft, with sensitivity analyses for infants.
Main Results:
- Overall pooled early survival was 96.0%, but significantly lower at 86.8% for infants.
- Pooled 10-year survival was 91.1% overall and 79.3% for infants.
- Infants had substantially higher mortality (HR: 3.38) and reintervention rates (51.2% for RVOT) compared to non-infant children, with younger age strongly linked to poorer outcomes.
Conclusions:
- The Ross procedure demonstrates modest survival and autograft reoperation rates in the pediatric population.
- Infancy is a critical factor associated with significantly poorer survival and increased reintervention rates following the Ross procedure.
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