Concha M, Casares J, Ross D N, González-Lavin L, Franco M, Mesa D, Legarra J J, Merino C, García Jiménez M A, Román M, Muñoz I, Alados P, Chacón A
Servicio de Cirugía Cardiovascular, Hospital Universitario Reina Sofía, Córdoba.
Rev Esp Cardiol. 1999 Feb;52(2):113-20. doi: 10.1016/s0300-8932(99)74878-5.
Aortic valve replacement with the patients own pulmonary autograft (the Ross procedure) is by now, the best surgical method for the replacement of the diseased aortic valve in certain groups of patients, this is particularly true for young adults and children or neonates with complex left ventricular outflow tract obstructions. The procedure was described by Donald Ross in 1967, and many years have passed. So in view of the accumulated experience the indications have extended to a wide group of patients which include children, neonates and young adults with formal contraindications for anticoagulation. In this publication we present our experience and our preliminary results in a group of fifteen patients which include adult and pediatric.
In six patients the etiology of lesion was congenital and in the remainder nine the valve had an acquired lesion. Two patients had an open heart procedure before this operation both of them to relieve an obstruction to the left ventricular outflow tract. In this group of patients the Ross procedure was carried out inserting the pulmonary autograft in the aortic position as a total root which was always reconstructed with cryopreserved pulmonary homograft, the mean homograft diameter was 26.1 +/- 4 mm (19-35).
In all patients a transesophageal echocardiogram was performed in the operating room and postoperative, 1 or 2 months later. Only in one patient a mild aortic regurgitation was detected, no significant transaortic or transpulmonary gradients were detected postoperative. One patient was reoperated for bleeding in the postoperative course, there was no hospital mortality in our group and all the patients had an uneventful postoperative period. In the short term follow-up (41-155 days). All the patients are free of anticoagulant therapy, all them are in New York Heart Association Functional Class I.
The patients presented in this publication which include adult and pediatric, are the first group of patients operated in our country with some excellent preliminary results. We hope that this procedure will become popular and that other surgical groups will adopt it as another surgical tool to replace a diseased aortic valve.
采用患者自身肺动脉自体移植瓣膜进行主动脉瓣置换术（罗斯手术）目前是某些特定患者群体中置换病变主动脉瓣的最佳手术方法，对于患有复杂左心室流出道梗阻的年轻人、儿童或新生儿尤其如此。该手术由唐纳德·罗斯于1967年描述，至今已过去多年。鉴于积累的经验，其适应证已扩展至包括儿童、新生儿以及有抗凝治疗正式禁忌证的年轻人在内的广泛患者群体。在本出版物中，我们展示了在一组15例包括成人和儿童患者中的经验及初步结果。
6例患者病变病因是先天性的，其余9例瓣膜有后天性病变。2例患者在此手术前接受过心脏直视手术，均为缓解左心室流出道梗阻。在这组患者中，实施罗斯手术时将肺动脉自体移植瓣膜作为一个整体根部植入主动脉位置，该根部总是用低温保存的肺动脉同种异体移植物进行重建，同种异体移植物平均直径为26.1±4毫米（19 - 35毫米）。
所有患者在手术室及术后1或2个月后均接受了经食管超声心动图检查。仅1例患者检测到轻度主动脉瓣反流，术后未检测到明显的跨主动脉或跨肺动脉压差。1例患者术后因出血再次手术，本组无医院死亡病例，所有患者术后病程平稳。在短期随访（41 - 155天）中，所有患者均无需抗凝治疗，均处于纽约心脏协会心功能I级。
本出版物中呈现的包括成人和儿童的患者是我国首批接受该手术的患者群体，取得了一些出色的初步结果。我们希望该手术将得到推广，其他手术团队将采用它作为置换病变主动脉瓣的另一种手术工具。
