Serena Sibilio1, Alex Koziarz2,3, Emilie P Belley-Côté4,5, Graham R McClure3,5, Sarah MacIsaac3,6, Seleman J Reza3, Kevin J Um4, Alexandra Lengyel3, Pablo Mendoza3, Ali Alsagheir3,7, Hatim Alraddadi3, Saurabh Gupta3, Adriaan W Schneider8, Parth M Patel9, John W Brown10, Michael W A Chu11, Mark D Peterson12, Maral Ouzounian13, Domenico Paparella14, Ismail El-Hamamsy15, Richard P Whitlock3,5. 1. Facoltá di Medicina e Chirugia, University of Bari "Aldo Moro", Bari, Italy. 2. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Department of Surgery, Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada. 4. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 5. Population Health Research Institute, Hamilton, Ontario, Canada. 6. School of Medicine, Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland. 7. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. 8. Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands. 9. Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia. 10. Section of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana. 11. Department of Surgery, Division of Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada. 12. Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 13. Division of Cardiac Surgery, Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada. 14. Department of Emergency and Organ Transplant, Division of Cardiac Surgery and Santa Maria Hospital, GVM Care & Research, University of Bari "Aldo Moro", Bari, Italy. 15. Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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.
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.