Ross procedure: is the root replacement technique superior to the sub-coronary implantation technique? Long-term results.
There is controversy over the use of the Ross procedure with regard to the sub-coronary and root replacement technique and its long-term durability. A systematic review of the literature may provide insight into the outcomes of these two surgical subvariants. A systematic review of reports between 1967 and February 2013 on sub-coronary and root replacement Ross procedures was undertaken. Twenty-four articles were included and divided into (i) sub-coronary technique and (ii) root replacement technique. The 10-year survival rate for a mixed-patient population in the sub-coronary procedure was 87.3% with a 95% confidence interval (CI) of 79.7-93.4 and 89.1% (95% CI, 85.3-92.1) in the root replacement technique category. For adults, it was 94 vs 95.3% (CI, 88.9-98.1) and in the paediatric series it was 90 vs 92.7% (CI, 86.9-96.0), respectively. Freedom from reoperation at 10 years was, in the mixed population, 83.3% (95% CI, 69.9-93.4) and 93.3% (95% CI, 89.4-95.9) for sub-coronary versus root replacement technique, respectively. In adults, it was 98 vs 91.2% (95% CI, 82.4-295.8), and in the paediatric series 93.3 vs 92.0% (95% CI, 86.1-96.5) for sub-coronary versus root replacement technique, respectively. The Ross procedure arguably has satisfactory results over 5 and 10 years for both adults and children. The results do not support the advantages of the sub-coronary technique over the root replacement technique. Root replacement was of benefit to patients undergoing reoperations on neoaorta and for long-term survival in mixed series.
Department of Cardiovascular Surgery, University Hospital Lausanne, Lausanne, Switzerland denis.berdajs@chuv.ch.
Denis A
DA
Berdajs
Department of Cardiovascular Surgery, University Hospital Lausanne, Lausanne, Switzerland.
Mirza
M
Muradbegovic
Department of Cardiovascular Surgery, University Hospital Lausanne, Lausanne, Switzerland.
Daniel
D
Haselbach
Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zürich, Zürich, Switzerland.
Reto
R
Kofmehl
Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zürich, Zürich, Switzerland.
Johann
J
Steurer
Department of Cardiovascular Surgery, University Hospital Lausanne, Lausanne, Switzerland.
Enrico
E
Ferrari
Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zürich, Zürich, Switzerland.
Ulrike
U
Held
Department of Surgery and Anesthesiology, Cardio-Vascular Research, University Hospital Lausanne, Lausanne, Switzerland.
Ludwig K
LK
von Segesser
D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D016019:Survival Analysis
Aortic valve replacement; Heart valves; Pulmonary valve replacement; Ross procedure