Ross Procedure In Neonate And Infant Populations: A Multicenter Meta-analysis Review
David Kalfa, MD PhD1, Scarlett Tohme2, Shangqing Jiang3, Amee Shah1, Lindsay Freud1, Giovanni Ferrari1, Emile Bacha1.
1New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA, 2New York Medical College, Valhalla, NY, USA, 3Columbia University Mailman School of Public Health, New York, NY, USA.
Objective:The Ross procedure is the gold-standard for aortic valve replacement in neonates/infants, but there are too few reports in literature. This study aims to perform a metanalysis of early and late outcomes of the Ross/Ross-Konno procedures in neonate/infant patients.
Methods:A meta-analysis was performed in accordance with PRISMA guidelines. We systematically searched Ovid versions of MEDLINE and PubMed and studies included neonate/infant patients and if they reported any of the predetermined clinical outcomes. I2 assessed the heterogeneity between prevalence with double arcsine method to transform prevalence. MetaXL calculated a random-effect model to account for heterogeneity. Point estimate pooled prevalence along with its 95%CI was calculated.
Results:A total of 587 neonate/infant patients were included. Follow-up range was 5days-23years. Early mortality was reported in 22 studies with a prevalence of 18.28%(95%Cl:13.55%-23.54%). Estimates ranged from 0%-50%(p=0.01,I2=48.58%). Late mortality was reported in 22 studies with a prevalence of 9.67%(95%CI:5.85%-14.27%). Estimates ranged from 0%-53%(p=0.01,I2=46.05%). Autograft reintervention was reported in 18 studies with a prevalence of 19.18%(95%Cl:7.34%-34.50%). Estimates ranged from 0%-81.8% with high heterogeneity(p<0.001,I2=90.45%). Homograft reintervention was reported in 16 studies with a prevalence of 32.03%(95%Cl:20.98%-44.18%). Estimates ranged from 0%-92.3% with high heterogeneity(p<0.001,I2=75.88%).
Conclusions:The data suggest that the Ross/Ross-Konno procedure in neonate/infant patients carries a risk of early and late mortality and autograft and homograft reintervention. The high variability of results among centers confirms the need for high surgical expertise and good patient selection. Studies with longer follow-up are warranted to investigate the rate of autograft reintervention and the impact on long-term survival in this specific population.