Ozaslan Feyzan, Wittlinger Thomas, Monsefi Nadejna, Bouhmidi Tamimount, Theres Sinthu, Doss Mirko, Wimmer-Greinecker Gerhard, Moritz Anton
Department of Thoracic & Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt-Main, Germany.
Eur J Cardiothorac Surg. 2008 Sep;34(3):583-8; discussion 588. doi: 10.1016/j.ejcts.2008.05.056. Epub 2008 Jul 29.
The performance of the Ross procedure in the case of geometric mismatch between pulmonary autograft and a bicuspid aortic root has not yet been fully evaluated. To prevent geometrically caused autograft dysfunction, a modification of the surgical technique is necessary.
Between January 1996 and January 2007, 50 patients (33 male, 17 female; mean age 50+/-14 years; range 13-63 years) underwent replacement of a diseased bicuspid aortic valve (stenosis in 14 cases; insufficiency in 21; combined disease in 15) with a Ross procedure. The pulmonary autograft was inserted partially in supra-annular position to correct the geometric mismatch between the deeper base of the non-coronary sinus and the right/left coronary sinus. In 24 of these patients, additional tailoring of the non-coronary sinus was necessary. In eight patients the non-coronary sinus was covered with a glutaraldehyde treated autologous pericardial patch to prevent pseudoaneurysm formation. Patients were followed up 1, 2, 5 and 10 years postoperatively.
There were no early or late deaths. There were six reoperations. One patient was reoperated because of persistent severe aortic valve insufficiency 9 months postoperatively. Three patients were reoperated for formation of subannular pseudoaneurysm, 6, 9 and 30 months postoperatively. One patient was reoperated for closure of a paravalvular dehiscence. Another patient was reoperated 1 year postoperatively because of a severe pulmonary stenosis due to excessive calcification of the bioprosthesis. Echocardiographic follow-up of the remaining patients showed no evidence of residual or recurrent pulmonary autograft regurgitation or progression of aortic root dilatation.
Autograft replacement of the bicuspid aortic valve is challenging, as the geometric mismatch has to be adjusted. Valve dysfunction is avoided by a supra-annular implantation technique, but pseudoaneurysm formation at the base of the non-coronary sinus is a worrying aspect. Patch reinforcement may solve this issue.
在肺动脉自体移植物与二叶式主动脉根部存在几何形状不匹配的情况下，Ross手术的效果尚未得到充分评估。为防止因几何形状导致的自体移植物功能障碍，有必要对手术技术进行改良。
1996年1月至2007年1月期间，50例患者（男性33例，女性17例；平均年龄50±14岁；年龄范围13 - 63岁）接受了Ross手术，置换病变的二叶式主动脉瓣（14例为狭窄；21例为关闭不全；15例为合并病变）。将肺动脉自体移植物部分植入瓣环上方位置，以纠正非冠状动脉窦较深的基部与右/左冠状动脉窦之间的几何形状不匹配。在这些患者中，有24例需要对非冠状动脉窦进行额外修整。8例患者用经戊二醛处理的自体心包补片覆盖非冠状动脉窦，以防止假性动脉瘤形成。术后对患者进行1年、2年、5年和10年的随访。
无早期或晚期死亡病例。有6例再次手术。1例患者因术后9个月持续存在严重主动脉瓣关闭不全而再次手术。3例患者因瓣环下假性动脉瘤形成分别在术后6个月、9个月和30个月再次手术。1例患者因瓣周漏关闭而再次手术。另1例患者术后1年因生物假体过度钙化导致严重肺动脉狭窄而再次手术。其余患者的超声心动图随访未显示残余或复发性肺动脉自体移植物反流或主动脉根部扩张进展的证据。
二叶式主动脉瓣的自体移植物置换具有挑战性，因为必须调整几何形状不匹配的问题。通过瓣环上方植入技术可避免瓣膜功能障碍，但非冠状动脉窦基部的假性动脉瘤形成是一个令人担忧的问题。补片加固可能解决这一问题。
