Systematic review and meta-analysis of time-to-event long-term outcomes following the Ross procedure

• Type of Material: Article
• Authors: Junichi Shimamura, Emory University; Shinichi Fukuhara, University of Michigan, Ann Arbor; Yujiro Yokoyama, St. Luke's University; Hisato Takagi, Shizuoka Medical Center; Maral Ouzounian, University of Toronto; Toshiki Kuno, Albert Einstein College of Medicine
• Language: English
• Date: 2023-08-14
• Publisher: AME Publishing Company
• Publication Version: Final Published Version
• Copyright Statement: 2023 Journal of Thoracic Disease. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.21037/jtd-23-326
• Title of Journal or Parent Work: Journal of Thoracic Disease
• Volume: 15
• Issue: 9
• Start Page: 4693
• End Page: 4702
• Grant/Funding Information: None.
• Keywords: Ross procedure; aortic valve; pulmonary valve
• Research Categories: Health Sciences, General; Biology, Biostatistics; Health Sciences, Medicine and Surgery

Abstract

Background The optimal aortic valve substitute for non-elderly adults remains controversial. Recently, considerable data on the Ross procedure have accumulated. This study aimed to analyze long-term outcomes following the Ross procedure from the current literature using a meta-analysis of time-to-event outcomes. Methods A literature search was performed with MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar through June 2022; studies reporting clinical outcomes of the Ross procedure beyond 20 years were included for analysis. The outcomes of interest were late survival and freedom from surgical or percutaneous reintervention of the autograft or right ventricular outflow tract (RVOT). Results Six studies, including 4,910 patients (3,601 males), were identified and analyzed. Survival rate at 5, 10, 15, and 20 years was 99.9%±0.1%, 97.6%±0.5%, 94.3%±0.9%, and 87.4%±1.9%. Freedom from autograft reintervention at 5, 10, 15, and 20 years was 97.7%±0.5%, 95.3%±0.7%, 91.4%±1.2%, 84.8%±2.5%. Freedom from RVOT reintervention was 99.0%±0.3%, 99.0%±0.3%, 97.5%±0.7%, 93.3%±1.8%. Freedom from any valve reintervention (either autograft or RVOT) at 5, 10, 15, and 20 years was 95.8%±0.6%, 92.6%±0.9%, 88.5%±1.2%, 80.8%±2.5%. Conclusions This meta-analysis demonstrated that the Ross procedure was confirmed to provide excellent survival despite the need for reintervention of autograft or RVOT in approximately 20% of patients at 20 years.