Abstract 13847: The Ross Procedure versus Mechanical versus Bioprosthetic Aortic Valve Replacement: A Network Meta-Analysis
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.036 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".