Autograft reinforcement in the Ross procedure: A systematic review and patient-level meta-analysis

The Ross procedure is a well-established option for aortic valve replacement, although progressive autograft dilation remains a significant long-term complication. Although several reinforcement techniques have been proposed to address this issue, their effectiveness has yet to be rigorously evaluated.

A Preferred Reporting Items for Systematic reviews and Meta-Analyses-compliant search was conducted for studies involving reinforced Ross and nonreinforced Ross procedures. Meta-analysis with individual patient data assessed survival and freedom from autograft reoperation rates. Subgroup analyses were conducted for the various reinforcement methods.

Sixteen cohort studies comprising 2514 patients with the reinforced Ross procedure and 595 patients with the nonreinforced Ross procedure were included. Preoperative and perioperative characteristics were comparable between groups. Individual patient data analysis of comparative studies demonstrated superior survival in the reinforced Ross group, with 5-, 10-, and 15-year survivals of 100%, 98.8%, and 98.8% compared with 95.0%, 93.7%, and 82.6%, respectively, in the nonreinforced group (hazard ratio, 11.9, P = .016). Likewise, freedom from autograft reoperation at 5, 10, and 15 years was 96.4%, 94.2%, and 86.6% in the reinforced Ross group versus 95.8%, 87.6%, and 77.7% in the nonreinforced group, respectively (hazard ratio, 2.06, P < .001). Subgroup analysis showed comparable outcomes across different reinforcement techniques.

Reinforced Ross procedures are associated with improved survival and freedom from autograft reoperation rates compared with unsupported pulmonary autografts.