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Takkenberg JJ, Klieverik LM, Schoof PH, van Suylen RJ, van Herwerden LA, Zondervan PE, Roos-Hesselink JW, Eijkemans MJ, Yacoub MH, Bogers AJ. The Ross Procedure. Circulation 2009; 119:222-8. [DOI: 10.1161/circulationaha.107.726349] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Johanna J.M. Takkenberg
- 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,
| | - Loes M.A. Klieverik
- 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,
| | - Paul H. Schoof
- 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,
| | - Robert-Jan van Suylen
- 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,
| | - Lex A. van Herwerden
- 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,
| | - Pieter E. Zondervan
- 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,
| | - Jolien W. Roos-Hesselink
- 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,
| | - Marinus J.C. Eijkemans
- 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,
| | - Magdi H. Yacoub
- 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,
| | - Ad J.J.C. Bogers
- 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,
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