Outcomes after Ross procedure in adult patients: A meta-analysis and microsimulation.
J Card Surg
; 34(5): 285-292, 2019 May.
Article
en En
| MEDLINE
| ID: mdl-30866116
ABSTRACT
OBJECTIVE:
We conducted a meta-analysis to estimate the risk of adverse events, life expectancy, and event-free life expectancy after the Ross procedure in adults.METHODS:
We searched databases for reports evaluating the Ross procedure in patients aged more than or equal to 16 years of age. A microsimulation model was used to evaluate age- and gender-specific life expectancy for patients undergoing the Ross procedure.RESULTS:
Data were pooled from 63 articles totaling 19 155 patients from 20 countries. Perioperative mortality was 2.5% (95% confidence interval [CI] 1.9-3.1; N = 9978). We found a mortality risk of 5.9% (95% CI 4.8-7.2) at a mean follow-up of 7.2 years (N = 7573). The rate of perioperative clinically significant bleeding was 1.0% (95% CI 0.1-3.0); re-exploration for bleeding 4.6% (95% CI 3.1-6.3); postoperative clinically significant bleeding from 30 days until a mean of 7.1 years was 0.5% (95% CI 0.2-1.0). At a mean of 6.9 years of follow-up, reintervention rate of any operated valve was 7.9% (95% CI 5.7-10.3). The risk of valve thrombosis was 0.3% (95% CI 0.2-0.5) at 7.6 years; peripheral embolism 0.3% (95% CI 0.2-0.4) at 6.4 years; stroke 0.9% (95% CI 0.7-1.2) at 6.5 years; and endocarditis 2.1% (95% CI 1.6-2.6) at 8.0 years. Microsimulation reported a 40-year-old undergoing the Ross procedure to have a life expectancy of 35.4 years and event-free life expectancy of 26.6 years.CONCLUSIONS:
Ross procedure in nonelderly adults is associated with low mortality and low risk of adverse events both at short- and long-term follow-up. The surgical community must prioritize a large, expertize-based randomized controlled trial to definitively address the risks and benefits of the Ross procedure compared to conventional aortic valve replacement.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Válvula Aórtica
/
Simulación por Computador
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Implantación de Prótesis de Válvulas Cardíacas
Tipo de estudio:
Clinical_trials
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
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Risk_factors_studies
/
Systematic_reviews
Límite:
Adolescent
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Adult
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Humans
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Middle aged
Idioma:
En
Revista:
J Card Surg
Asunto de la revista:
CARDIOLOGIA
Año:
2019
Tipo del documento:
Article
País de afiliación:
Italia