Ross Versus Konno for Aortic Valve Replacement in Children: Meta-Analysis and Systematic Review

Abstract Background: Aortic valve replacement (AVR) is a chal-lenging strategy, competing aortic valve repair in pediatric population. However, there is no consensus among surgeons about the optimal strategy to choose in pediatric and infant patients. Despite being potential surgical options for AVR in pediatric patients, there is no currently available evidence comparing the clinical outcomes of Ross vs Konno procedures in candidate pediatric population. Aim of Study: This study aimed to analyze the currently available evidence assessing the surgical outcomes of Ross and Konno procedures in pediatric patients undergoing AVR. Material and Methods: A systematic search of the PubMed, google scholar, Embase, Egyptian knowledge bank (EKB), MEDLINE and Cochrane Central Register databases. Obser-vational and randomized controlled trials assessing pediatric population underwent aortic valve replacement (AVR) through Ross or Konno procedures. Outcomes assessed were early and late mortality, reoperation, and post-operative complication rates. The quality of the included studies was evaluated using the Cochrane risk of bias assessment. Additionally, publication bias was double checked using both funnel plots and Eager's test. Results: A total of 16 studies were included in the current analysis, including 1814 patients underwent AVR, utilizing either Ross or Konno procedures. Our results suggested comparable lower rates of mortality including early [RR 0.64 95% CI (0.37-1.12) p=0.12] and late mortality [RR 0.59, 95% CI (0.33-1.08); p=0.12], and thrombotic complications [RR 0.57, 95% CI 0.08-4.06; p=0.92]. Reoperation [1.22, 95% CI (0.82-1.82; p=0.33) and bleeding events [RR 1.41, 95% CI (0.71-2.79); p=0.41] compared to Konno. Nevertheless, the composite endpoint of complications suggested significantly lower risk with Ross compared to Konno in pediatric popula-tion (Rate ratio 0.57, 95% CI (0.37-0.87); p<0. 01). Conclusion: In comparison to Konno procedure, Ross procedure in children undergoing aortic valve replacement should be the standard golden procedure due to its superiority and the comparable lower rates of early and late mortality with reduced reoperation rates compared to Konno procedure.