Comparative Long-Term Outcomes of Subcoronary Versus Full-Root Techniques in the Ross Procedure: A Meta-Analysis and Meta-Regression

Cubas W.S.; Gundelach J.; Alfabeto A.; Kawaguchi Y.; Chu M.W.A. · Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery (2026) · DOI: 10.1177/15569845261489278

Resumen

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. © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Instituciones: Universidad Científica del Sur