Brown John W, Ruzmetov Mark, Fukui Toshihiro, Rodefeld Mark D, Mahomed Yousuf, Turrentine Mark W
Section of Cardiothoracic Surgery, James W. Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana 46202-5123, USA.
J Heart Valve Dis. 2006 Mar;15(2):253-9; discusson 259-60.
The optimal hemodynamic performance and potential for growth of the pulmonary autograft has led to expanded indications for the Ross aortic valve replacement (AVR) procedure in some centers. The authors' institutional mid-term experience was reviewed to assess autograft and homograft hemodynamics, growth profile of the autograft, and reoperative frequency following Ross AVR.
Between June 1993 and June 2005, 167 consecutive patients (mean age 24.9 +/- 15.5 years; range: 1 month to 61 years) underwent Ross AVR: 48% of patients were aged < 19 years. Additional procedures (n = 78) were performed in 55 patients (33%) at the time of the Ross procedure. In total, 151 patients had isolated aortic valve disease and 16 pediatric patients had more complex, multi-level left ventricular outflow tract obstruction.
There were two early deaths (1.2%) and one late death (0.6%) over a mean follow up of 5.1 +/- 3.0 years (range: 1 month to 11 years). Actuarial survival at 10 years was 98%. In pediatric patients with Konno procedure (n = 16), the pulmonary autograft mean annulus diameter increased from 10.2 to 19.9 mm. Twelve patients underwent 12 reoperations without mortality for autograft insufficiency or an ascending aortic aneurysm at a median interval of 5 years (range: 2 to 8 years): aortic annuloplasty and ascending aorta replacement (n = 4), composite aortic root replacement (n = 7), and repair of left ventricular pseudoaneurysm (n = 1). Freedom from replacement of the pulmonary autograft was 96% at 10 years. Five of the 164 surviving patients (3%) developed significant obstruction of the pulmonary homograft and required conduit replacement at a median of four years.
The Ross AVR can be performed with good mid-term results, including the pediatric age group. The potential for development of significant autograft insufficiency and homograft stenosis warrants annual follow up through the intermediate and late terms.
肺动脉自体移植物具有最佳的血流动力学性能和生长潜力，这使得一些中心扩大了Ross主动脉瓣置换术（AVR）的适应证。回顾作者所在机构的中期经验，以评估自体移植物和同种异体移植物的血流动力学、自体移植物的生长情况以及Ross AVR术后的再次手术频率。
1993年6月至2005年6月，167例连续患者（平均年龄24.9±15.5岁；范围：1个月至61岁）接受了Ross AVR：48%的患者年龄＜19岁。55例患者（33%）在Ross手术时还进行了其他手术（n = 78）。共有151例患者患有单纯主动脉瓣疾病，16例儿科患者患有更复杂的、多级左心室流出道梗阻。
在平均5.1±3.0年（范围：1个月至11年）的随访中，有2例早期死亡（1.2%）和1例晚期死亡（0.6%）。10年的精算生存率为98%。在接受Konno手术的儿科患者（n = 16）中，肺动脉自体移植物的平均瓣环直径从10.2 mm增加到19.9 mm。12例患者接受了12次再次手术，均未因自体移植物功能不全或升主动脉瘤死亡，中位间隔时间为5年（范围：2至8年）：主动脉瓣环成形术和升主动脉置换术（n = 4）、复合主动脉根部置换术（n = 7）以及左心室假性动脉瘤修复术（n = 1）。10年时肺动脉自体移植物无需置换的自由度为96%。164例存活患者中有5例（3%）出现了同种异体肺动脉移植物的严重梗阻，中位时间为4年，需要进行管道置换。
Ross AVR手术可取得良好的中期效果，包括儿科年龄组。自体移植物严重功能不全和同种异体移植物狭窄的发生可能性使得在中期和后期需要每年进行随访。
