Key result
Subcoronary technique matches full-root technique for long-term mortality in the Ross procedure.
Why the study?
The Ross procedure has excellent results across techniques, but long-term comparative data on subcoronary versus full-root approaches are needed to assess durability and outcomes.
Does the subcoronary technique compared to the full-root technique improve long-term mortality, autograft failure, and reintervention in patients undergoing the Ross procedure?
Meta-Analysis (n=2,064)
Does the subcoronary technique compared to the full-root technique improve long-term mortality, autograft failure, and reintervention in patients undergoing the Ross procedure?
The subcoronary and full-root techniques for the Ross procedure demonstrated comparable long-term outcomes for mortality, reintervention, and autograft failure, suggesting the approach should be patient-tailored based on surgical expertise and anatomy.
No difference in long-term autograft durability between SC and FR Ross techniques; extends evidence for technique flexibility in high-volume centers.
Objective: The Ross procedure has demonstrated excellent results across various techniques. This meta-analysis compares subcoronary (SC) and full-root (FR) techniques, assessing long-term autograft failure, reintervention, and mortality to compare each approach and durability. Methods: A literature search in PubMed, Embase, Scopus, and Cochrane identified studies (1970 to 2025) comparing SC versus FR Ross techniques with a minimum follow-up of 1 year. A random-effects meta-analysis assessed mortality, autograft failure, and reintervention. Meta-regression evaluated study-level covariate impact on long-term outcomes and durability. Results: Five observational studies were included (2,064 patients; 1,118 SC, 946 FR) with a mean age of 22.7 years and 12.8-year follow-up. SC patients were slightly older and had more congenital heart disease. FR was associated with longer cardiopulmonary bypass and cross-clamp times, with no differences in gender, valve morphology, or New York Heart Association class. Outcomes were comparable for mortality (relative risk [RR] = 0.95, 95% confidence interval [CI]: 0.72 to 1.25), reintervention (RR = 1.02, 95% CI: 0.42 to 2.46), and autograft failure (RR = 0.90, 95% CI: 0.36 to 2.23; hazard ratio = 0.88, 95% CI: 0.63 to 1.24). Meta-regression identified age and prior infective endocarditis as predictors of mortality, whereas longer follow-up modestly reduced reintervention risk, suggesting durable autograft performance or competing risks over time. Conclusions: This meta-analysis reveals comparable long-term outcomes between Ross procedure techniques. It likely reflects surgical expertise and preference, suggesting the approach should be patient tailored, as neither proves superior. Further research is needed to optimize individualized strategies.
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Cubas et al. (2026) conducted a meta-analysis in Aortic valve disease requiring Ross procedure (n=2,064). Subcoronary technique vs. Full-root technique was evaluated on Mortality (RR 0.95, 95% CI 0.72 to 1.25). The subcoronary technique for the Ross procedure demonstrated comparable long-term mortality to the full-root technique (RR 0.95; 95% CI 0.72-1.25).
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