Learning curve of the Ross procedure after more than 650 interventions: a single-centre, retrospective analysis
Bibliographic record
Abstract
OBJECTIVES: The Ross procedure has been associated with better long-term outcomes in selected patients. Nevertheless, its complexity has limited its adoption. The aim of this study was to assess the learning curve of the Ross procedure and to evaluate the impact of new surgeons joining an experienced Ross program. METHODS: From 2011 to 2023, 673 consecutive Ross procedures were performed in adults (<69 years) at the Montreal Heart Institute. The cohort was divided into 3 groups depending on the previous experience of the operating surgeon. Safety (including mortality and major complications), efficiency (cardiopulmonary bypass and aortic cross-clamp times) and efficacy end-points (aortic regurgitation >1/4) were compared. Cumulative sum analyses were performed to evaluate mortality and major complications. RESULTS: There were 3 (0.45%) peri-operative mortalities. All analysed outcomes exhibited temporal trends towards improvement. Major complications decreased from 9.5% in the Early period to 1.8% in the Late (P = 0.019). Similarly, there was a statistically significant improvement in median cardiopulmonary bypass (from 203.5 min in the Early period to 163.5 in the Late, P < 0.001) and aortic cross-clamp times (from 180 min in the Early period to 148 in the Late, P < 0.001). CONCLUSIONS: Improvement in safety, efficiency and resource utilization were observed after an initial learning period. Addition of new surgeons to an established Ross program did not negatively impact surgical outcomes. Mortality and morbidity remained low and were compared favourably with predicted risks for conventional AVR. The Ross procedure is reproducible with adequate mentorship and support to help minimize individual learning curves. CLINICAL TRIAL REGISTRATION NUMBER: #2017-1974.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".