The Ross Procedure in Children and Infants: A Systematic Review With Pooled Analyses
Bibliographic record
Abstract
Background The Ross procedure is a surgical option for congenital aortic stenosis that involves replacing the diseased aortic valve with a pulmonary autograft. Little is known about outcomes in children, particularly those under 1 year of age. Methods A systematic review with pooled analyses was conducted according to PRISMA criteria. Inferred individual patient data were extracted from life tables. The primary endpoints were early (≤30 days) and late (>30 days) mortality rates following the Ross procedure in children. Secondary endpoints were freedom from reintervention for the right ventricular outflow tract and pulmonary autograft. These endpoints were assessed in the overall population of children. Sensitivity analyses were performed in subgroups younger than 1 year of age (infants) and in non-infant children. Results A total of 25 studies on 2737 patients met inclusion criteria. The pooled early survival rate was 96.0% [95% CI (95.1 to 96.8%)] overall and 86.8% [95% CI (82.1% to 90.3%)] among infants. Pooled overall 10-year survival, freedom from pulmonary autograft reintervention, and freedom from right ventricular outflow tract reintervention rates were 91.1%, 90.2% and 79.7%, respectively. Corresponding pooled rates in infants were 79.3%, 87.1%, and 51.2%. Mortality was significantly higher among infants compared to non-infant children [hazard ratio 3.38, 95% CI (2.44; 4.68), p<0.001]. In meta-regression analyses, younger age was strongly associated with poorer survival and higher reintervention rates. Conclusion Modest survival and autograft reoperation rates were observed following the Ross procedure in children. Surgery in infancy was strongly associated with poorer survival and higher reintervention rates.
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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 | 0.014 | 0.036 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.026 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
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".