Hanke Thorsten, Stierle Ulrich, Boehm Juergen O, Botha Cornelius A, Matthias Bechtel J F, Erasmi Armin, Misfeld Martin, Hemmer Wolfgang, Rein Joachim G, Robinson Derek R, Lange Rüdiger, Hörer Jürgen, Moritz Anton, Ozaslan Feyzan, Wahlers Thorsten, Franke Ulrich F W, Hetzer Roland, Hübler Michael, Ziemer Gerhard, Graf Bernhard, Ross Donald N, Sievers Hans H
Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Germany.
Circulation. 2007 Sep 11;116(11 Suppl):I251-8. doi: 10.1161/CIRCULATIONAHA.106.678797.
Autograft regurgitation and root dilatation after the Ross procedure is of major concern. We reviewed data from the German Ross Registry to document the development of autograft regurgitation and root dilatation with time and also to compare 2 different techniques of autograft implantation.
Between 1990 and 2006 1014 patients (786 men, 228 women; mean age 41.2+/-15.3 years) underwent the Ross procedure using 2 different implantation techniques (subcoronary, n=521; root replacement, n=493). Clinical and serial echocardiographic follow up was performed preoperatively and thereafter annually (mean follow up 4.41+/-3.11 years, median 3.93 years, range 0 to 16.04 years; 5012 patient-years). For statistical analysis of serial echocardiograms, a hierarchical multilevel modeling technique was applied. Eight early and 28 late deaths were observed. Pulmonary autograft reoperations were required in 35 patients. Initial autograft regurgitation grade was 0.49 (root replacement 0.73, subcoronary 0.38) with an annual increase of grade 0.034 (root replacement 0.0259, subcoronary 0.0231). Annulus and sinus dimensions did not exhibit an essential increase over time in both techniques, whereas sinotubular junction diameter increased essentially by 0.5 mm per year in patients with root replacement. Patients with the subcoronary implantation technique showed nearly unchanged dimensions. Bicuspid aortic valve morphology did not have any consistent impact on root dimensions with time irrespective of the performed surgical technique.
The present Ross series from the German Ross Registry showed favorable clinical and hemodynamic results. Development of autograft regurgitation for both techniques was small and the annual progression thereof is currently not substantial. Use of the subcoronary technique and aortic root interventions with stabilizing measures in root replacement patients seem to prevent autograft regurgitation and dilatation of the aortic root within the timeframe studied.
Ross手术后自体肺动脉瓣反流和根部扩张是主要关注点。我们回顾了德国Ross注册研究的数据，以记录自体肺动脉瓣反流和根部扩张随时间的发展情况，并比较两种不同的自体肺动脉瓣植入技术。
1990年至2006年间，1014例患者（786例男性，228例女性；平均年龄41.2±15.3岁）接受了Ross手术，采用两种不同的植入技术（冠状动脉下植入，n = 521；根部置换，n = 493）。术前及此后每年进行临床及系列超声心动图随访（平均随访4.41±3.11年，中位数3.93年，范围0至16.04年；共5012患者年）。对于系列超声心动图的统计分析，应用了分层多级建模技术。观察到8例早期死亡和28例晚期死亡。35例患者需要进行自体肺动脉瓣再次手术。初始自体肺动脉瓣反流分级为0.49（根部置换为0.73，冠状动脉下植入为0.38），每年增加0.034级（根部置换为0.0259，冠状动脉下植入为0.0231）。两种技术中，瓣环和窦部尺寸随时间均未呈现显著增加，而根部置换患者的窦管交界直径每年基本增加0.5 mm。采用冠状动脉下植入技术的患者尺寸几乎无变化。无论采用何种手术技术，二叶式主动脉瓣形态随时间对根部尺寸均无一致影响。
德国Ross注册研究中的当前Ross系列显示出良好的临床和血流动力学结果。两种技术的自体肺动脉瓣反流进展均较小且目前每年进展不显著。在本研究时间范围内，采用冠状动脉下技术以及对根部置换患者采取稳定措施的主动脉根部干预似乎可预防自体肺动脉瓣反流和主动脉根部扩张。
