Schmidtke C, Bechtel J f, Hueppe M, Noetzold A, Sievers H H
Departments of Cardiac Surgery and Anesthesiology, Medical University of Luebeck, Luebeck, Germany.
J Thorac Cardiovasc Surg. 2000 May;119(5):990-7. doi: 10.1016/S0022-5223(00)70094-8.
In the Ross procedure, 3 different techniques are used for aortic valve replacement with the pulmonary autograft: freestanding root, inclusion, and subcoronary implantation. The objective of this study was to evaluate echocardiographically the influence of the particular operative technique on dimension, distensibility, and valve function.
Between February 1990 and August 1998, the Ross procedure was performed in 111 patients (mean age, 48.6 +/- 14.1 years; range, 15.2-70.6 years), with 1 early and 1 late death, 1 autograft replacement, and 1 patient lost to follow-up. The remaining patients underwent the freestanding root (n = 9 patients), inclusion (n = 14 patients), and subcoronary techniques (n = 84 patients). Echocardiography was performed at a mean follow-up of 26 +/- 21.3 months after operation and was compared with the echocardiographic findings of the control subjects (n = 10 subjects). Root sizes were measured at the level of the anulus, sinus, and supra-aortic ridge; the distensibility was calculated as pressure strain elastic modulus and percent change of radius.
Size and distensibility of the aortic root were normal, except for a larger diameter at the sinus level in the root technique in comparison to the subcoronary technique (P <.05; maximum diameter, 41.3 +/- 8.6 mm vs 32.6 +/- 4.0 mm). Aortic valve function was comparable among groups with low pressure gradients and most patients with no or trace aortic insufficiency.
The freestanding root, inclusion, and subcoronary techniques in the Ross procedure provide comparable excellent hemodynamics, normal root size, and distensibility, except for the enlarged sinus diameter in the freestanding root. These results may have some impact on the operative procedure and follow-up investigations.
在罗斯手术中，有3种不同技术用于用自体肺动脉瓣置换主动脉瓣：独立根部技术、纳入技术和冠状动脉下植入技术。本研究的目的是通过超声心动图评估特定手术技术对尺寸、扩张性和瓣膜功能的影响。
1990年2月至1998年8月期间，对111例患者（平均年龄48.6±14.1岁；范围15.2 - 70.6岁）实施了罗斯手术，其中1例早期死亡、1例晚期死亡、1例进行了自体瓣膜置换，1例患者失访。其余患者分别接受了独立根部技术（n = 9例）、纳入技术（n = 14例）和冠状动脉下技术（n = 84例）。术后平均随访26±21.3个月时进行了超声心动图检查，并与对照组（n = 10例）的超声心动图结果进行比较。在瓣环、窦部和主动脉上嵴水平测量根部尺寸；扩张性以压力应变弹性模量和半径变化百分比计算。
主动脉根部的尺寸和扩张性正常，但独立根部技术组窦部水平的直径比冠状动脉下技术组更大（P <.05；最大直径，41.3±8.6 mm对32.6±4.0 mm）。各组间主动脉瓣功能相当，压力梯度较低，大多数患者无或仅有微量主动脉瓣反流。
罗斯手术中的独立根部技术、纳入技术和冠状动脉下技术提供了相当出色的血流动力学、正常的根部尺寸和扩张性，除了独立根部技术的窦部直径增大。这些结果可能对手术操作和随访研究有一定影响。
