- Compared with mechanical aortic valve replacement (AVR), the Ross procedure was associated with better survival and other outcomes but higher reintervention rates in this meta-analysis.
- Most data derived from observational studies; randomized trials needed.
- Authors emphasize need for careful patient selection with Ross.
Why this matters
- Evidence suggests elevated mortality among younger patients undergoing mechanical AVR.
- Ross procedure eliminates anticoagulation and attendant risks but is surgically complex and of uncertain benefit vs mechanical AVR.
- Median follow-up, 5.8 years.
- Ross vs mechanical AVR:
- Mortality: incidence rate ratio (IRR), 0.54 (95% CI, 0.35-0.82; P=.004);
- Valve- or cardiac-related mortality: IRR, 0.42 (95% CI, 0.18-0.97; P=.04);
- Heart block requiring pacemaker: risk ratio, 0.40 (95% CI, 0.17-0.94; P=.04);
- Stroke: IRR, 0.26 (95% CI, 0.09-0.80; P=.02);
- Major bleeding: IRR, 0.17 (95% CI, 0.07-0.40; P<.001>
- Mean transaortic valve gradient difference: 9.8 mmHg (P<.001>
- Reintervention: IRR, 1.76 (95% CI, 1.16-2.65; P=.007);
- Similar rates of perioperative mortality and morbidity, endocarditis.
- Systematic review, meta-analysis, 18 studies (1 randomized clinical trial) comparing Ross procedure vs mechanical AVR (n=3516).
- Outcome: all-cause mortality.
- Funding: None disclosed; authors report industry ties.
- Few randomized data.
- Follow-up inadequate to explore risks for valve deterioration.
- Variable Ross techniques, mechanical valve types not assessed.