title: The Ross procedure: a systematic review and meta-analysis.
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.
  
  
  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 < or =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.
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
authors.forename: Loes M A
authors.initials: LM
authors.lastname: Klieverik
authors.forename: Paul H
authors.initials: PH
authors.lastname: Schoof
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Suylen
authors.forename: Lex A
authors.initials: LA
authors.lastname: van Herwerden
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Zondervan
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D000818:Animals; D001705:Bioprosthesis / Q000592:standards / Q000639:trends*; D006350:Heart Valve Prosthesis / Q000592:standards / Q000639:trends*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000592:standards / Q000639:trends*; D006801:Humans; D011475:Prosthesis Failure; D013997:Time Factors