Analysis: Ross Procedure Associated with Positive Outcomes

Adults undergoing a Ross procedure for mechanical aortic valve replacement saw a reduction in mortality, according to results from a new meta-analysis published in JAMA Cardiology. 

Researchers for the analysis looked at 18 studies (one randomized clinical trial and 17 observational studies) in which the Ross procedure was used for mechanical prostheses in adults undergoing aortic valve replacement. A total of 3,516 patients were included in the analysis. The outcome of interest was all-cause mortality. Patients were followed for a median of 5.8 years. 

Superior outcomes with the Ross operation versus mechanical aortic valve replacement in adults: a systematic review and meta-analysis https://t.co/LYEx9pnczT

— JAMA Cardiology (@JAMACardio) August 25, 2018

According to the results, there was a 46% reduction in all-cause mortality in patients undergoing a Ross procedure compared to traditional mechanical aortic valve replacement (incidence rate ratio [IRR]=0.54; 95% CI, 0.35 to 0.82; P=0.004). In addition, the Ross procedure was also associated with lower stroke rates (IRR=0.26; 95% CI, 0.09 to 0.80; P=0.02). Higher rates of reintervention were reported in patients undergoing the Ross procedure, however (IRR=0.76; 95% CI, 1.16 to 2.65; P=0.007). 

“The article by Mazine et al […] is a welcome addition to the accumulating evidence of the superiority of the Ross operation,” Magdi Yacoub, OM, FRS, wrote in an accompanying editorial. “The authors present the first and to my knowledge only meta-analysis comparing outcomes of the Ross operation with those of mechanical prostheses (currently the recommended and most common aortic valve substitute) in young and middle-aged adults.” 

meta-analysis of 3516 adults who had Ross procedure [aortic valve is replaced with own pulmonary valve] and found a 46% lower incidence of all-cause mortality compared with patients undergoing mechanical aortic valve replacement, https://t.co/wPIbMtd2gQ

— Prof Derek Connolly (@DrDerekConnolly) August 26, 2018

the Ross operation – great operation when done well. It however has a shortcomings that are very difficult to overcome – not least of which is need for a surgeon with great skill & judgement, #aorticstenosis @brheartvalvesoc https://t.co/88tfvL4Egg

— Norman Briffa MD 📣 🇲🇹🇬🇧🇺🇦 (@Chestcracker) August 26, 2018

Thanks for sharing. In ACHD: many old Ross. Patient selection & surgical experience is key. Advances in technique to avoid autograft dilation made a difference. Important conversation: right time for prospective studies @JAMA_current @ACCinTouch @FredWuMD #ESCCongress https://t.co/afpxqlNy9g

— Ami Bhatt, MD (@AmiBhattMD) August 26, 2018

It was a pleasure collaborating on this study further demonstrating superior survival and quality of life with the Ross procedure in adults undergoing aortic valve replacement. Bravo @AmineMazineMD @OuzounianMD @ICMtl @PMunkCardiacCtr @tssmn #Rossprocedure #aorticvalvereplacement https://t.co/HV33Nu8f9k

— Ismail El-Hamamsy, MD, PhD (@IHamamsy) August 25, 2018

Source: JAMA Cardiology