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(Circulation. 2009;119:222-228.)
© 2009 American Heart Association, Inc.

Cardiovascular Surgery

The Ross Procedure

A Systematic Review and Meta-Analysis

Johanna J.M. Takkenberg, MD, PhD; Loes M.A. Klieverik, MD, PhD; Paul H. Schoof, MD, PhD; Robert-Jan van Suylen, MD, PhD; Lex A. van Herwerden, MD, PhD; Pieter E. Zondervan, MD, PhD; Jolien W. Roos-Hesselink, MD, PhD; Marinus J.C. Eijkemans, PhD; Magdi H. Yacoub, MD, PhD; Ad J.J.C. Bogers, MD, PhD

From the Departments of Cardiothoracic Surgery (J.J.M.T., L.M.A.K., A.J.J.C.B.), Pathology (P.E.Z.), Cardiology (J.W.R.-H.), and Public Health (M.J.C.E.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands (P.H.S.); Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands (R.J.v.S.); Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands (L.A.v.H.); and National Heart and Lung Institute, Heart Science Centre, Harefield, United Kingdom (M.H.Y.).

Correspondence to Loes Klieverik, MD, PhD, Department of Cardiothoracic Surgery, Bd 571, Erasmus University, Medical Center, PO Box 2040, 3000CA Rotterdam, The Netherlands. E-mail l.klieverik{at}erasmusmc.nl

Received August 8, 2007; accepted October 14, 2008.

Background— Reports on outcome after the Ross procedure are limited by small study size and show variable durability results. A systematic review of evidence on outcome after the Ross procedure may improve insight into outcome and potential determinants.

Methods and Results— A systematic review of reports published from January 2000 to January 2008 on outcome after the Ross procedure was undertaken. Thirty-nine articles meeting the inclusion criteria were allocated to 3 categories: (1) consecutive series, (2) adult patient series, and (3) pediatric patient series. With the use of an inverse variance approach, pooled morbidity and mortality rates were obtained. Pooled early mortality for consecutive, adult, and pediatric patients series was 3.0% (95% confidence interval [CI], 1.8 to 4.9), 3.2% (95% CI, 1.5 to 6.6), and 4.2% (95% CI, 1.4 to 11.5). Autograft deterioration rates were 1.15% (95% CI, 1.06 to 2.06), 0.78% (95% CI, 0.43 to 1.40), and 1.38%/patient-year (95% CI, 0.68 to 2.80), respectively, and for right ventricular outflow tract conduit were 0.91% (95% CI, 0.56 to 1.47), 0.55% (95% CI, 0.26 to 1.17), and 1.60%/patient-year (95% CI, 0.84 to 3.05), respectively. For studies with mean patient age >18 years versus mean patient age 18 years, pooled autograft and right ventricular outflow tract deterioration rates were 1.14% (95% CI, 0.83 to 1.57) versus 1.69% (95% CI, 1.02 to 2.79) and 0.65% (95% CI, 0.41 to 1.02) versus 1.66%/patient-year (95% CI, 0.98 to 2.82), respectively.

Conclusions— The Ross procedure provides satisfactory results for both children and young adults. Durability limitations become apparent by the end of the first postoperative decade, in particular in younger patients.

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CLINICAL PERSPECTIVE

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