罗斯手术：它是年轻主动脉瓣疾病患者的理想手术吗？

Affonso da Costa F D, Pinton R, Haggi Filho H, da Rosa G S, Abuchaim D C, Quintaneiro V, Milani R, Ito R, Gaspar R, Burger M, Sallum F, Faraco D L, Affonso da Costa I A

Heart Surgery Service, Santa Casa de Curitiba and Hospital Infantil Pequeno Principe, Curitiba, PR-Brazil.

Heart Surg Forum. 1998;1(2):116-24.

BACKGROUND

Aortic valve prosthesis with adequate hemodynamic performance should allow more complete left ventricular mass regression and normalize left ventricular function. This possibly affects long-term prognosis after aortic valve replacement.

OBJECTIVE

Assessment of hemodynamic performance of pulmonary autograft in the aortic position and the regression of left ventricular mass after the Ross procedure.

METHODS

Between May 1995 and March 1996, 45 patients with mean age of 27.1 years underwent a Ross procedure. Doppler echocardiography and cardiac catheterization were performed on all patients before hospital discharge to evaluate the hemodynamic performance of auto- and homografts, as well as to evaluate left ventricular mass and function. Fourteen patients with follow-up longer than six months were submitted to dobutamine stress echocardiography to study the hemodynamic performance of auto- and homografts during exercise.

RESULTS

Hospital mortality was 6%. After a mean follow-up of 12.8 months (1-23 months) there was one late sudden death. No valve-related event was observed during this period. Immediate and late hemodynamic performance of the pulmonary autografts were normal with an average mean gradient of 1.8 +/- 0.6 mmHg and an average maximum instantaneous gradient of 2.9 +/- 0.9 mmHg. Valvular insufficiency was insignificant. Even during exercise, gradients did not increase significantly with an average mean gradient of 4.3 +/- 2.5 mmHg and an average maximum gradient of 10.4 +/- 6.1 mmHg. Homografts used for right ventricular reconstruction showed excellent immediate hemodynamic performance. However, at late follow-up an increase in flow speed was observed with an average to mean gradient of 10 +/- 7.1 mmHg at rest and 26 +/- 13.2 mmHg during exercise. Left ventricular mass index was normal at rest and during exercise in the majority of patients.

CONCLUSION

Given the normal hemodynamic function of pulmonary autografts, the reduction of ventricular mass and normalization of left ventricular function, in addition to the excellent late follow-up of the patients, the Ross procedure is considered the operation of choice for young patients requiring aortic valve replacement.

背景

具有良好血流动力学性能的主动脉瓣假体应能使左心室质量更完全地消退，并使左心室功能正常化。这可能会影响主动脉瓣置换术后的长期预后。

目的

评估主动脉位置的肺动脉自体移植的血流动力学性能以及Ross手术后左心室质量的消退情况。

方法

1995年5月至1996年3月期间，45例平均年龄27.1岁的患者接受了Ross手术。所有患者在出院前均进行了多普勒超声心动图和心导管检查，以评估自体移植物和同种异体移植物的血流动力学性能，以及评估左心室质量和功能。14例随访时间超过6个月的患者接受了多巴酚丁胺负荷超声心动图检查，以研究运动期间自体移植物和同种异体移植物的血流动力学性能。

结果

医院死亡率为6%。平均随访12.8个月（1 - 23个月）后有1例晚期猝死。在此期间未观察到与瓣膜相关的事件。肺动脉自体移植物的即刻和晚期血流动力学性能正常，平均平均压差为1.8±0.6 mmHg，平均最大瞬时压差为2.9±0.9 mmHg。瓣膜关闭不全不明显。即使在运动期间，压差也没有显著增加，平均平均压差为4.3±2.5 mmHg，平均最大压差为10.4±6.1 mmHg。用于右心室重建的同种异体移植物显示出优异的即刻血流动力学性能。然而，在晚期随访中观察到流速增加，静息时平均平均压差为10±7.1 mmHg，运动时为26±13.2 mmHg。大多数患者在静息和运动时左心室质量指数正常。