The Ross procedure versus prosthetic and homograft aortic valve replacement: a systematic review and meta-analysis Academic Article uri icon

  • Overview
  • Research
  • Identity
  • Additional Document Info
  • View All


  • OBJECTIVES: Young adults undergoing aortic valve replacement (AVR) have decreased life expectancy compared to matched controls. The Ross procedure aims to improve valve lifespan while avoiding anticoagulation. We prepared a systematic review and meta-analysis to assess the Ross procedure compared to conventional AVR. METHODS: We searched MEDLINE, EMBASE and Cochrane CENTRAL for studies evaluating the Ross procedure versus any conventional AVR in adult patients. We performed screening, full-text assessment, risk of bias evaluation and data collection independently and in duplicate. We evaluated the risk of bias with the ROBINS-I and Cochrane tools and quality of evidence with the GRADE framework. We pooled data using the random- and fixed-effects models. RESULTS: Thirteen observational studies and 2 randomized controlled trials (RCTs) were identified (n = 5346). No observational study was rated as having low risk of bias. The Ross procedure was associated with decreased late mortality in observational and RCT data [mean length of follow-up 2.6 years, relative risk (RR) 0.56, 95% confidence interval (CI) 0.38-0.84, I2 = 58%, very low quality]. The RCT estimate of effect was similar (mean length of follow-up 8.8 years, RR 0.33, 95% CI 0.11-0.96, I2 = 66%, very low quality). No difference was observed in mortality <30 days after surgery. All-site reintervention was similar between groups in cohorts and significantly reduced by the Ross procedure in RCTs (RR 1.41, 95% CI 0.89-2.24, I2 = 55%, very low quality and RR 0.41, 95% CI 0.22-0.78, I2 = 68%, high quality, respectively). CONCLUSIONS: Observational data, with residual confounding, and RCT data suggest a late survival benefit with the Ross procedure with no increased risk of reintervention when compared to conventional AVR. Considering the quality of available evidence and limited follow-up, additional high-quality randomized studies are required to strengthen these findings. Systematic review PROSPERO registration: CRD42016052512.


  • McClure, Graham R
  • Belley-Cote, Emilie
  • Um, Kevin
  • Gupta, Saurabh
  • Bouhout, Ismail
  • Lortie, Hugo
  • Alraddadi, Hatim
  • Alsagheir, Ali
  • McIntyre, William F
  • Dorobantu, Dan-Mihai
  • Bossard, Matthias
  • Kim, Kevin
  • Stoica, Serban
  • Eikelboom, John
  • Ouzounian, Maral
  • Chu, Michael WA
  • Parry, Dominic
  • El-Hamamsy, Ismail
  • Whitlock, Richard

publication date

  • February 1, 2019