ArticleJTCVS techniques2026
Complete Dacron reinforcement of Ross autograft does not increase neoaortic valve regurgitation: A systematic review and meta-analysis.
Article in JTCVS techniques, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: The Ross procedure offers superior hemodynamics and growth potential for patients with unrepairable aortic valve disease, but pulmonary autograft dilation and progressive neoaortic valve regurgitation remain key limitations. Complete autograft reinforcement with Dacron has been proposed to enhance structural stability and prevent dilation. However, concerns persist regarding potential autograft distortion, impaired leaflet coaptation, and increased valve regurgitation. This systematic review and meta-analysis compares clinical outcomes of fully Dacron-supported versus unsupported or partially supported autografts in the Ross procedure. Methods: A comprehensive literature search of PubMed, Web of Science, Cochrane, and Scopus databases was conducted from inception through March 30, 2026. Five retrospective comparative cohort studies including a total of 526 patients met inclusion criteria. Outcomes evaluated were early mortality (≤30 days), overall survival, freedom from autograft reoperation, and incidence of moderate or greater neoaortic valve regurgitation. Pooled risk ratios (RRs) with 95% CIs were calculated using random-effects meta-analysis. Results: No significant differences were observed between fully supported and unsupported/partially supported groups for early mortality (RR, 2.52; 95% CI, 0.28-22.51; Conclusions: Complete Dacron reinforcement of the pulmonary autograft does not increase the risk of neoaortic valve regurgitation or adversely affect clinical outcomes compared with unsupported or partially supported autografts. This technique offers a viable strategy to improve autograft durability and may enable the Ross procedure's application in patients previously deemed suboptimal candidates. Surgical technique should be tailored to individual patient profiles and institutional expertise, rather than standardized adoption of one technique.
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