Frigiola Alessandro, Ranucci Marco, Carlucci Concetta, Giamberti Alessandro, Abella Raul, Di Donato Marisa
Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, Milan, Italy.
Ann Thorac Surg. 2008 Aug;86(2):482-9. doi: 10.1016/j.athoracsur.2008.04.001.
This is a clinical investigation of the mid- to long-term follow-up of the Ross procedure in adult patients. The primary end point is to explore the incidence and risk factors for a reoperation on the pulmonary autograft. The secondary end points are to explore the incidence of neoaortic root dilation and valve regurgitation, and the echocardiographic profile leading to a reoperation.
Ross operations were done in 110 adults who received at least two echocardiographic examinations for a mean follow-up time of 82 months (range, 5 to 155 months). Kaplan-Meier and Cox regression analyses were applied to assess freedom from events and risk factors for events.
Freedom from reoperation on the pulmonary autograft, neoaortic root dilation, and moderate-severe neoaortic valve regurgitation were, respectively, 91.4%, 50%, and 70% at 12 years. The main risk factor for a reoperation was the degree of neoaortic valve regurgitation within the first 2 years of follow-up. Patients requiring an early (<or=4 years) reoperation had early and severe pulmonary autograft valve regurgitation, and no neoaortic root dilation. Patients needing a late (>4 years) reoperation had severe neoaortic root dilation and severe neoaortic valve regurgitation. The left ventricular end-diastolic diameter at the third year of follow-up was a risk factor for late reoperation.
The Ross operation in adults is a safe procedure with good clinical results in mid- to long-term follow-up. Early reoperations are due to early neoaortic valve regurgitation, wheras late reoperations are due to progressive neoaortic root dilation.
这是一项针对成年患者Ross手术中长期随访的临床研究。主要终点是探讨肺动脉自体移植再次手术的发生率及危险因素。次要终点是探讨新主动脉根部扩张和瓣膜反流的发生率，以及导致再次手术的超声心动图特征。
对110例成年患者进行了Ross手术，这些患者至少接受了两次超声心动图检查，平均随访时间为82个月（范围为5至155个月）。应用Kaplan-Meier和Cox回归分析来评估事件的无事件生存率和危险因素。
在12年时，肺动脉自体移植无再次手术、新主动脉根部无扩张以及无中重度新主动脉瓣反流的生存率分别为91.4%、50%和70%。再次手术的主要危险因素是随访前2年内新主动脉瓣反流的程度。需要早期（≤4年）再次手术的患者存在早期且严重的肺动脉自体移植瓣膜反流，且无新主动脉根部扩张。需要晚期（>4年）再次手术的患者存在严重的新主动脉根部扩张和严重的新主动脉瓣反流。随访第三年时的左心室舒张末期直径是晚期再次手术的危险因素。
成年患者的Ross手术是一种安全的手术，在中长期随访中临床效果良好。早期再次手术是由于早期新主动脉瓣反流，而晚期再次手术是由于进行性新主动脉根部扩张。
