TY - JOUR
T1 - Long-Term Outcomes of Ross Procedure versus Mechanical Aortic Valve Replacement
T2 - Meta-Analysis of Reconstructed Time-To-Event Data
AU - Sá, Michel Pompeu
AU - Van den Eynde, Jef
AU - Jacquemyn, Xander
AU - Tasoudis, Panagiotis
AU - Erten, Ozgun
AU - McDonald, Connor
AU - Weymann, Alexander
AU - Ruhparwar, Arjang
AU - Clavel, Marie Annick
AU - Pibarot, Philippe
AU - Calhoon, John
AU - Ramlawi, Basel
N1 - Funding Information:
Philippe Pibarot has echocardiography Core Laboratory contracts with Edwards Lifesciences, for which he receives no direct compensation. Marie-Annick Clavel has computed tomography Core Laboratory contract with Edwards Lifesciences, for which she receives no direct compensation and received research grant from Medtronic. Basel Ramlawi has received financial support from Medtronic, Corcym, and AtriCure. All other authors have reported that they have no relationships relevant to the contents of this study to disclose.
Funding Information:
Michel Pompeu Sá receives support from The Thoracic Surgery Foundation (charitable arm of The Society of Thoracic Surgeons – STS) through the TSF Every Heartbeat Matters Global Structural Heart Fellowship Award for the project “Structural Heart/Minimally Invasive Cardiac Surgery”
Funding Information:
Sharpe - Strumia Research Foundation (Bryn Mawr Hospital), Michel Pompeu Sá receives support from The Thoracic Surgery Foundation (charitable arm of The Society of Thoracic Surgeons – STS) through the TSF Every Heartbeat Matters Global Structural Heart Fellowship Award for the project “Structural Heart/Minimally Invasive Cardiac Surgery”
Publisher Copyright:
© 2022
PY - 2022
Y1 - 2022
N2 - In the era of lifetime management of aortic valve disease, the Ross procedure emerged as an alternative to prosthetic heart valves for young adults; however, more long-term data are warranted. We performed a meta-analysis of reconstructed time-to-event data to compare long-term outcomes between the Ross procedure and mechanical aortic valve replacement (mAVR) in young adults. PubMed/MEDLINE, EMBASE and GoogleScholar were searched for studies comparing Ross procedure with mAVR that reported mortality/survival rates and/or reoperation rates accompanied by at least one Kaplan-Meier curve for any of the outcomes. Six observational studies (5 with propensity score matching) including 5024 patients (Ross: 1737; mAVR: 3287) met our inclusion criteria. Patients who underwent Ross had a significantly lower risk of mortality in the overall population (HR 0.38, 95%CI 0.30-0.49, P<0.001; median follow-up of 7.2 years) and in the propensity score matched cohorts (HR 0.55, 95%CI 0.42-0.73, P<0.001; median follow-up of 10.2 years); however, the incidence function for the cumulative risk of reoperation was higher for the Ross procedure (HR 1.91, 95%CI 1.36-2.70, P<0.001; median follow-up of 9.3 years). Data from observational studies suggest that the Ross procedure is associated with lower all-cause mortality compared with mAVR; however, there is a higher risk of reoperation. Besides serving as basis to inform patients about benefits and risks involved in this choice, these results call for further randomized clinical trials to determine whether the Ross procedure can achieve its potential benefits in young patients in need of AVR.
AB - In the era of lifetime management of aortic valve disease, the Ross procedure emerged as an alternative to prosthetic heart valves for young adults; however, more long-term data are warranted. We performed a meta-analysis of reconstructed time-to-event data to compare long-term outcomes between the Ross procedure and mechanical aortic valve replacement (mAVR) in young adults. PubMed/MEDLINE, EMBASE and GoogleScholar were searched for studies comparing Ross procedure with mAVR that reported mortality/survival rates and/or reoperation rates accompanied by at least one Kaplan-Meier curve for any of the outcomes. Six observational studies (5 with propensity score matching) including 5024 patients (Ross: 1737; mAVR: 3287) met our inclusion criteria. Patients who underwent Ross had a significantly lower risk of mortality in the overall population (HR 0.38, 95%CI 0.30-0.49, P<0.001; median follow-up of 7.2 years) and in the propensity score matched cohorts (HR 0.55, 95%CI 0.42-0.73, P<0.001; median follow-up of 10.2 years); however, the incidence function for the cumulative risk of reoperation was higher for the Ross procedure (HR 1.91, 95%CI 1.36-2.70, P<0.001; median follow-up of 9.3 years). Data from observational studies suggest that the Ross procedure is associated with lower all-cause mortality compared with mAVR; however, there is a higher risk of reoperation. Besides serving as basis to inform patients about benefits and risks involved in this choice, these results call for further randomized clinical trials to determine whether the Ross procedure can achieve its potential benefits in young patients in need of AVR.
KW - aortic valve
KW - autograft
KW - cardiac surgical procedures
KW - cardiovascular surgical procedures
KW - heart valve prosthesis implantation
KW - meta-analysis
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UR - http://www.scopus.com/inward/citedby.url?scp=85133301758&partnerID=8YFLogxK
U2 - 10.1016/j.tcm.2022.06.005
DO - 10.1016/j.tcm.2022.06.005
M3 - Review article
C2 - 35750311
AN - SCOPUS:85133301758
SN - 1050-1738
JO - Trends in Cardiovascular Medicine
JF - Trends in Cardiovascular Medicine
ER -