Brown John W, Ruzmetov Mark, Vijay Palaniswamy, Rodefeld Mark D, Turrentine Mark W
Section of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202-5123, USA.
Ann Thorac Surg. 2006 Oct;82(4):1301-6. doi: 10.1016/j.athoracsur.2006.05.001.
The Ross aortic valve replacement with a modified Konno-type enlargement Ross-Konno procedure of the aortic annulus and subannular region allows an autograft aortic valve replacement for children with significant annular and subannular hypoplasia. The potential for growth and the proven durability of the autograft make the Ross-Konno procedure an ideal aortic valve replacement for this subgroup with multilevel left ventricular outflow tract obstruction. We reviewed our institutional midterm experience to assess autograft and homograft hemodynamics, and management after a Ross-Konno procedure.
Between 1995 and 2005, 14 consecutive children (mean age, 6.4 +/- 5.9 years; range, 1 month to 17 years) underwent the Ross-Konno procedure. All children had severe to critical aortic stenosis or multilevel left ventricular outflow tract obstruction.
There was 1 early and 1 late death with a mean follow-up of 5.7 +/- 3.6 years. Actuarial survival at 10 years was 86%. Three patients underwent right ventricular outflow tract reoperation for conduit replacement for homograft dysfunction and one patient required redo aortic root replacement with a mechanical valves for progressive aortic insufficiency. Freedom from right ventricular outflow tract and autograft reoperation at 10 years is 77% and 92%, respectively. Aortic annular dilation was not observed in all patients. Univariate and multivariate analysis identified no risk factors for autograft or homograft valve-related reoperation.
The Ross-Konno procedure is an excellent technique to treat complex multilevel left ventricular outflow tract obstruction in children with significant annular and subannular hypoplasia. The autograft demonstrated durability without development of aortic stenosis or progressive dilation and a low incidence of developing progressive aortic insufficiency. Enlargement of the aortic annulus appear to parallel somatic growth in most instances.
采用改良的Konno型主动脉瓣环及瓣下区域扩大术（Ross-Konno手术）进行Ross主动脉瓣置换术，可使自体主动脉瓣置换应用于伴有严重瓣环及瓣下发育不全的儿童患者。自体移植物的生长潜力以及已证实的耐久性，使得Ross-Konno手术成为该组伴有多级左心室流出道梗阻患者理想的主动脉瓣置换术。我们回顾了本机构的中期经验，以评估Ross-Konno手术后自体移植物和同种异体移植物的血流动力学及管理情况。
1995年至2005年间，连续14例儿童（平均年龄6.4±5.9岁；范围1个月至17岁）接受了Ross-Konno手术。所有儿童均患有重度至极重度主动脉瓣狭窄或多级左心室流出道梗阻。
有1例早期死亡和1例晚期死亡，平均随访时间为5.7±3.6年。10年的预期生存率为86%。3例患者因同种异体移植物功能障碍接受了右心室流出道再次手术以更换管道，1例患者因进行性主动脉瓣关闭不全需要用机械瓣膜进行再次主动脉根部置换。10年时无右心室流出道和自体移植物再次手术的自由度分别为77%和92%。并非所有患者均观察到主动脉瓣环扩张。单因素和多因素分析均未发现自体移植物或同种异体移植物瓣膜相关再次手术的危险因素。
Ross-Konno手术是治疗伴有严重瓣环及瓣下发育不全的儿童复杂多级左心室流出道梗阻的一项优秀技术。自体移植物显示出耐久性，未出现主动脉瓣狭窄或进行性扩张，且发生进行性主动脉瓣关闭不全的发生率较低。在大多数情况下，主动脉瓣环的扩大似乎与身体生长平行。
