Pediatric Ross Procedure: Systematic Review Using Individual Data Pooling
Nabil DIB, Walid Ben Ali, Paul Khairy, Thierry Ducruet, Pierre-Luc Bernier, Nancy Poirier.
Montreal Heart Institute, Montreal, QC, Canada.
Objective(s): Ross procedure in children, especially in infants (<1 year), has been the subject of a small number of cohort studies. Using life tables from individual validated studies using graphical approach (Digitizelt®) provides more accurate access to data of early and late mortality in addition to cumulative autograft and pulmonary valve (PVR) dysfunction.
Methods: Systematic review was conducted with PRISMA criteria. Pubmed, Medline and Embase studies published between January 2000 and March 2022 were included. Time-to-event model assessed early and late mortality in addition to reoperative cumulative incidence autograft and PVR dysfunction. Heterogeneity between studies was tested using log-rank.
Results: Twenty studies (n=2041 patients) were included for individual data pooling. Median follow up was 8.3 years (IQR: 5.0-13.1 years). Overall pooled estimates of early (30 days) and 15-years mortality rates were 4.0% (95% CI, 3.2% to 5.0%) and 14.2% (95% CI, 11.1% to 18.2%), respectively. Fifteen-year cumulative incidence of reoperation for autograft and PVR dysfunction were 21.5% (95% CI, 18.0% to 25.5%) and 34.4% (95% CI, 30.6% to 38.6%), respectively. Infant pooled estimated of early and 5-year mortality rates were 12.5% (95% CI, 8.7% to 17.8%) and 20.0% (95% CI, 14.7% to 27.1%) respectively. Five-year cumulative incidence of autograft and PVR dysfunction were 6.8% (95% CI: 2.1% to 20.8%) and 28.8% (95% CI: 21.9% to 37.3%), respectively.
Pediatric Ross procedure offers a short and long term solution including infant with a good survival and autograft reoperation rate. However, PVR remains problematic in all age categories.
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