Choudhary S K, Mathur A, Sharma R, Saxena A, Chopra P, Roy R, Kumar A S
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi.
J Thorac Cardiovasc Surg. 1999 Sep;118(3):483-90; discussion 490-1. doi: 10.1016/S0022-5223(99)70186-8.
Although pulmonary autograft is being increasingly used to replace the diseased aortic valve with excellent long-term results, its use in the population with rheumatic disease still needs careful evaluation.
From October 1993 through March 1998, 102 patients underwent aortic valve replacement with a pulmonary autograft (Ross procedure). The mean age was 27.9 +/- 4.2 years (range, 0.8-56 years). The cause was rheumatic disease in 75 patients (73%), bicuspid aortic valve in 26 patients (26%), and myxomatous aortoarteritis in 1 patient (1%). The root replacement technique was used in all. In addition, 31 patients had 33 associated procedures: mitral valve repair (n = 15 patients), open mitral commissurotomy (n = 15 patients), tricuspid repair (n = 2 patients), and homograft mitral valve replacement (n = 1 patient).
Operative mortality was 6.9% (7 patients). Late mortality was 7.8% (8 patients). Follow-up ranged from 1 to 60 months (mean, 25.3 +/- 15.4 months) and was 98% complete. Two patients required reoperation for failed mitral valve repair, and 2 other patients underwent reoperation for failure of both the autograft and mitral valve repair. Echocardiographic assessment showed moderate to severe aortic regurgitation in 13 patients, along with thickening of the autograft. All of these patients had rheumatic disease and were young (<30 years). Ten of these patients had undergone associated mitral valve procedure. Morphologic and histopathologic examination of explanted autografts showed features compatible with rheumatic valvulitis.
Pulmonary autograft is susceptible to rheumatic involvement. Young age (<30 years) and associated mitral valve disease are significant risk factors for autograft failure in patients with rheumatic disease. Use of pulmonary autograft in this subgroup of patients requires a cautious approach.
尽管肺动脉自体移植术越来越多地用于替换病变的主动脉瓣，且长期效果良好，但其在风湿性疾病患者中的应用仍需谨慎评估。
1993年10月至1998年3月，102例患者接受了肺动脉自体移植主动脉瓣置换术（Ross手术）。平均年龄为27.9±4.2岁（范围0.8 - 56岁）。病因是风湿性疾病75例（73%），二叶式主动脉瓣26例（26%），黏液瘤样主动脉动脉炎1例（1%）。均采用了根部置换技术。此外，31例患者进行了33项相关手术：二尖瓣修复（15例患者）、直视二尖瓣交界切开术（15例患者）、三尖瓣修复（2例患者）、同种异体二尖瓣置换术（1例患者）。
手术死亡率为6.9%（7例患者）。晚期死亡率为7.8%（8例患者）。随访时间为1至60个月（平均25.3±15.4个月），随访完整性为98%。2例患者因二尖瓣修复失败需再次手术，另外2例患者因自体移植瓣膜和二尖瓣修复均失败而接受再次手术。超声心动图评估显示13例患者存在中至重度主动脉瓣反流，同时自体移植瓣膜增厚。所有这些患者均患有风湿性疾病且年龄较小（<30岁）。其中10例患者接受了相关二尖瓣手术。取出的自体移植瓣膜的形态学和组织病理学检查显示符合风湿性瓣膜炎的特征。
肺动脉自体移植瓣膜易受风湿累及。年龄较小（<30岁）和合并二尖瓣疾病是风湿性疾病患者自体移植瓣膜失败的重要危险因素。在这一亚组患者中使用肺动脉自体移植瓣膜需要谨慎对待。
