Abstract 13847: The Ross Procedure versus Mechanical versus Bioprosthetic Aortic Valve Replacement: A Network Meta-Analysis

Abstract

Background: The Ross operation appears to restore normal survival in young and middle-aged adults with aortic valve disease. However, there is limited data comparing it to conventional aortic valve replacement options. Objectives: To compare outcomes of the Ross procedure, mechanical and bioprosthetic aortic valve replacement (M-AVR, B-AVR). Methods: MEDLINE and EMBASE were searched through March 2022 to identifyrandomized controlled trials (RCTs) and propensity-score matched studies (PSMs) that investigated outcomes of patients ≥16-year-old undergoing the Ross procedure, M-AVR or B-AVR. Result: The systematic literature search identified 2 RCTs and 8 PSMs involving a total of 4,812 patients (Ross: n=1,991; M-AVR: n=2,019; B-AVR: n=802). All-cause mortality was significantly lower in the Ross procedure group compared with M-AVR (hazard rate (HR) [95% confidence interval (CI)]=0.58 [0.35-0.97], P=0.035) and BAVR (HR [95% CI]=0.32 [0.18-0.59], P <0.001) groups. The reintervention rate was lower in the Ross and M-AVR groups compared with B-AVR (HR [95% CI] =0.31 [0.15-0.65], P=0.002, HR [95% 272 CI] =0.15 [0.05-0.41], P< 0.001, respectively), while it was higher after the Ross procedure compared with M-AVR group (HR [95% CI] =2.12 [1.04-4.33], P=0.039). However, post-Ross reinterventions included both autograft and right ventricular outflow tract. Major bleeding rate was lower after the Ross procedure compared with M-AVR. Long-term stroke rate was lower following the Ross procedure compared with M-AVR and B-AVR. The rate of endocarditis was also lower after the Ross procedure compared with B-AVR. Conclusion: Improved long-term outcomes of the Ross procedure are demonstrated compared with conventional M-AVR and B-AVR options. These results highlight a need to enhance the recognition of the Ross procedure and revisit current guidelines regarding the optimal valve substitute for young and middle-aged patients.