TY - JOUR
T1 - The Ross procedure versus prosthetic and homograft aortic valve replacement
T2 - A systematic review and meta-analysis
AU - McClure, Graham R.
AU - Belley-Cote, Emilie P.
AU - Um, Kevin
AU - Gupta, Saurabh
AU - Bouhout, Ismail
AU - Lortie, Hugo
AU - Alraddadi, Hatim
AU - Alsagheir, Ali
AU - McIntyre, William F.
AU - Dorobantu, Dan Mihai
AU - Bossard, Matthias
AU - Kim, Kevin
AU - Stoica, Serban
AU - Eikelboom, John
AU - Ouzounian, Maral
AU - Chu, Michael W.A.
AU - Parry, Dominic
AU - El-Hamamsy, Ismail
AU - Whitlock, Richard P.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - OBJECTIVES: Young adults undergoing aortic valve replacement (AVR) have decreased life expectancy compared to matched controls. The Ross procedure aims to improve valve lifespan while avoiding anticoagulation. We prepared a systematic review and meta-analysis to assess the Ross procedure compared to conventional AVR. METHODS: We searched MEDLINE, EMBASE and Cochrane CENTRAL for studies evaluating the Ross procedure versus any conventional AVR in adult patients. We performed screening, full-text assessment, risk of bias evaluation and data collection independently and in duplicate. We evaluated the risk of bias with the ROBINS-I and Cochrane tools and quality of evidence with the GRADE framework. We pooled data using the random- and fixed-effects models. RESULTS: Thirteen observational studies and 2 randomized controlled trials (RCTs) were identified (n = 5346). No observational study was rated as having low risk of bias. The Ross procedure was associated with decreased late mortality in observational and RCT data [mean length of follow-up 2.6 years, relative risk (RR) 0.56, 95% confidence interval (CI) 0.38-0.84, I2 = 58%, very low quality]. The RCT estimate of effect was similar (mean length of follow-up 8.8 years, RR 0.33, 95% CI 0.11-0.96, I2 = 66%, very low quality). No difference was observed in mortality <30 days after surgery. All-site reintervention was similar between groups in cohorts and significantly reduced by the Ross procedure in RCTs (RR 1.41, 95% CI 0.89-2.24, I2 = 55%, very low quality and RR 0.41, 95% CI 0.22-0.78, I2 = 68%, high quality, respectively). CONCLUSIONS: Observational data, with residual confounding, and RCT data suggest a late survival benefit with the Ross procedure with no increased risk of reintervention when compared to conventional AVR. Considering the quality of available evidence and limited followup, additional high-quality randomized studies are required to strengthen these findings.
AB - OBJECTIVES: Young adults undergoing aortic valve replacement (AVR) have decreased life expectancy compared to matched controls. The Ross procedure aims to improve valve lifespan while avoiding anticoagulation. We prepared a systematic review and meta-analysis to assess the Ross procedure compared to conventional AVR. METHODS: We searched MEDLINE, EMBASE and Cochrane CENTRAL for studies evaluating the Ross procedure versus any conventional AVR in adult patients. We performed screening, full-text assessment, risk of bias evaluation and data collection independently and in duplicate. We evaluated the risk of bias with the ROBINS-I and Cochrane tools and quality of evidence with the GRADE framework. We pooled data using the random- and fixed-effects models. RESULTS: Thirteen observational studies and 2 randomized controlled trials (RCTs) were identified (n = 5346). No observational study was rated as having low risk of bias. The Ross procedure was associated with decreased late mortality in observational and RCT data [mean length of follow-up 2.6 years, relative risk (RR) 0.56, 95% confidence interval (CI) 0.38-0.84, I2 = 58%, very low quality]. The RCT estimate of effect was similar (mean length of follow-up 8.8 years, RR 0.33, 95% CI 0.11-0.96, I2 = 66%, very low quality). No difference was observed in mortality <30 days after surgery. All-site reintervention was similar between groups in cohorts and significantly reduced by the Ross procedure in RCTs (RR 1.41, 95% CI 0.89-2.24, I2 = 55%, very low quality and RR 0.41, 95% CI 0.22-0.78, I2 = 68%, high quality, respectively). CONCLUSIONS: Observational data, with residual confounding, and RCT data suggest a late survival benefit with the Ross procedure with no increased risk of reintervention when compared to conventional AVR. Considering the quality of available evidence and limited followup, additional high-quality randomized studies are required to strengthen these findings.
KW - Aortic valve replacement
KW - Bioprosthetic valve replacement
KW - Homograft valve replacement
KW - Mechanical valve replacement
KW - Pulmonary autograft
KW - The Ross procedure
UR - http://www.scopus.com/inward/record.url?scp=85060139748&partnerID=8YFLogxK
U2 - 10.1093/ejcts/ezy247
DO - 10.1093/ejcts/ezy247
M3 - Article (Academic Journal)
C2 - 30084899
AN - SCOPUS:85060139748
SN - 1010-7940
VL - 55
SP - 247
EP - 255
JO - European Journal of Cardio-Thoracic Surgery
JF - European Journal of Cardio-Thoracic Surgery
IS - 2
ER -
