Outcomes after Ross procedure in adult patients: A meta‐analysis and microsimulation

Abstract

Objective We conducted a meta‐analysis to estimate the risk of adverse events, life expectancy, and event‐free life expectancy after the Ross procedure in adults. Methods We searched databases for reports evaluating the Ross procedure in patients aged more than or equal to 16 years of age. A microsimulation model was used to evaluate age‐ and gender‐specific life expectancy for patients undergoing the Ross procedure. Results Data were pooled from 63 articles totaling 19 155 patients from 20 countries. Perioperative mortality was 2.5% (95% confidence interval [CI]: 1.9‐3.1; N = 9978). We found a mortality risk of 5.9% (95% CI: 4.8‐7.2) at a mean follow‐up of 7.2 years (N = 7573). The rate of perioperative clinically significant bleeding was 1.0% (95% CI: 0.1‐3.0); re‐exploration for bleeding 4.6% (95% CI: 3.1‐6.3); postoperative clinically significant bleeding from 30 days until a mean of 7.1 years was 0.5% (95% CI: 0.2‐1.0). At a mean of 6.9 years of follow‐up, reintervention rate of any operated valve was 7.9% (95% CI: 5.7‐10.3). The risk of valve thrombosis was 0.3% (95% CI: 0.2‐0.5) at 7.6 years; peripheral embolism 0.3% (95% CI: 0.2‐0.4) at 6.4 years; stroke 0.9% (95% CI: 0.7‐1.2) at 6.5 years; and endocarditis 2.1% (95% CI: 1.6‐2.6) at 8.0 years. Microsimulation reported a 40‐year‐old undergoing the Ross procedure to have a life expectancy of 35.4 years and event‐free life expectancy of 26.6 years. Conclusions Ross procedure in nonelderly adults is associated with low mortality and low risk of adverse events both at short‐ and long‐term follow‐up. The surgical community must prioritize a large, expertize‐based randomized controlled trial to definitively address the risks and benefits of the Ross procedure compared to conventional aortic valve replacement.

Survival and freedom from reoperation after the Ross procedure in a Russian adult population: A single-center experience

“…The rate of autograft reinterventions differs between studies, and common indications for reoperation include the neoaortic root dilatation, infective endocarditis, technical failures, and others. 6 , 8 , 11 , 12 In the current study, the freedom from reoperation for the autograft was 89.1% (95% CI, 81.2%-97.8%) at 11 years. The main causes of autograft reintervention were dilatation of the neoaortic root and the ascending aorta.…”

Ross for Valve replacement In AduLts (REVIVAL) pilot trial: rationale and design of a randomised controlled trial

“…All-cause mortality, selected rather than cardiovascular mortality, as cause-specific mortality is often difficult to ascertain or define in complex cardiovascular patients in whom multiend-organ dysfunction may accompany cardiovascular decline. 0.46% 17 1.81% 30 2.94% 30…”

The Ross procedure is the optimal solution for young adults with unrepairable aortic valve disease

“…In fact, when implanted in young and middleaged adults, both bioprosthetic and mechanical valves are associated with excess mortality, which appears to be inversely proportional to patient age at the time of surgery (15)(16)(17)(18). The majority of recent studies examining longterm outcomes following AVR have shown that the Ross procedure is the only operation capable of restoring expected survival equivalent to that of the age and gendermatched general population (2,3). Whereas no study has shown similar results following AVR with conventional prostheses or aortic homografts, even in highly selected patient series (7,16).…”

“…Although standard mechanical or biological prostheses remain the most common choice selected across most age groups, young adults represent a unique group of patients because of their anticipated long life expectancy and thus higher cumulative risk of prosthesis-related complications. The Ross procedure, unlike conventional bioprosthetic or mechanical AVR, provides an expected survival equivalent to that of the age and gender-matched general population by minimizing prosthesis-related complications, avoidance of anticoagulation, and superior hemodynamics (2,3).…”