Raja Shahzad Gull, Pozzi Marco
Department of Paediatric Cardiothoracic Surgery, Alder Hey Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom.
BMC Cardiovasc Disord. 2004 Apr 19;4:3. doi: 10.1186/1471-2261-4-3.
The ideal prosthesis for aortic valve replacement in children and young adults has not been found yet. In recent years there has been a renewed interest in the replacement of aortic valve with the pulmonary autograft owing to its advantages of lack of anticoagulation, potential for growth and excellent haemodynamic performance. The purpose of this study was to review our institutional experience at Alder Hey hospital with the Ross procedure in children and young adults.
From November 1996 to September 2003, 38 patients (mean age, 13.1 +/- 5.7 years) underwent the Ross procedure for various aortic valve diseases using the root replacement technique. Clinical and echocardiographic follow-up was performed early (within 30 days), 3 to 6 months, and yearly after surgery. Medical records of all patients were reviewed retrospectively.
There was 1 perioperative death. The patients were followed-up for a median interval of 36 months and up to 7 years. One patient died 3 years after surgery secondary to ventricular arrhythmia with overall mortality of 5.3%. Actuarial survival at 7 years was 94 +/- 2.5% and there was 100% freedom from reoperation for autograft valve dysfunction or any other cause. Balloon dilatation was required in 2 patients for pulmonary homograft stenosis. The haemodynamics at the latest follow-up were also similar to those at the time of discharge after surgery. There was no progression in the degree of aortic regurgitation for 11 patients with trivial and 3 with mild regurgitation.
Our experience demonstrates that Ross operation is an attractive option for aortic valve replacement in children and young adults. Not only can the operation be accomplished with a low operative risk but the valve function stays normal over a long period of time with minimal alteration in lifestyle and no need for repeated operations to replace the valve as a result of somatic growth of the children.
尚未找到适用于儿童和年轻成人主动脉瓣置换的理想人工瓣膜。近年来，由于肺动脉自体移植瓣膜具有无需抗凝、有生长潜力以及出色的血流动力学性能等优点，人们对其用于主动脉瓣置换重新产生了兴趣。本研究的目的是回顾我们在奥尔德希医院对儿童和年轻成人进行罗斯手术的机构经验。
1996年11月至2003年9月，38例患者（平均年龄13.1±5.7岁）因各种主动脉瓣疾病采用根部置换技术接受了罗斯手术。术后早期（30天内）、3至6个月以及每年进行临床和超声心动图随访。对所有患者的病历进行了回顾性分析。
围手术期死亡1例。患者的中位随访时间为36个月，最长达7年。1例患者术后3年因室性心律失常死亡，总死亡率为5.3%。7年的精算生存率为94±2.5%，因自体移植瓣膜功能障碍或任何其他原因再次手术的自由度为100%。2例患者因肺动脉同种异体移植瓣膜狭窄需要进行球囊扩张。最新随访时的血流动力学也与术后出院时相似。11例轻度主动脉瓣反流和3例轻度主动脉瓣反流患者的主动脉瓣反流程度没有进展。
我们的经验表明罗斯手术是儿童和年轻成人主动脉瓣置换的一个有吸引力的选择。该手术不仅可以在低手术风险下完成，而且瓣膜功能在很长一段时间内保持正常，对生活方式影响最小，并且由于儿童身体生长无需重复进行瓣膜置换手术。
