Böhm Jürgen O, Hemmer Wolfgang, Rein Joachim-Gerd, Horke Alexander, Roser Detlef, Blumenstock Gunnar, Botha Cornelius A
Sana Cardiac Surgical Clinic, Stuttgart, Germany.
Ann Thorac Surg. 2009 Feb;87(2):514-20. doi: 10.1016/j.athoracsur.2008.10.093.
Although the Ross operation requires double-valve replacement for aortic valve pathology, it is the only autologous, aortic valve replacement available. We report a single-unit's 11-year experience.
Before August 2006, 467 patients (mean age, 41 +/- 15 years; 358 males) underwent a Ross operation. The right ventricular outflow tract was repaired with a cryopreserved pulmonary homograft. Follow-up was 94.4% complete.
The 30-day mortality was 0.6%. The Kaplan-Meier survival estimate at 120 months was 94.4% +/- 2.9% (standard error [SE], 0.0146). Reoperation was due to autograft failure in 15 patients (7 repairs, 8 replacements), with a Kaplan-Meier freedom from autograft failure measured as reoperation or regurgitation exceeding grade II at 120 months of 94.2% +/- 2.8% (SE, 0.0142). Homograft replacement, mostly due to stenosis, occurred in 11 patients. Freedom from homograft dysfunction, defined as homograft reoperation or peak homograft gradient of 30 mm Hg or more, at 120 months was 79.3% +/- 7.3% (SE, 0.0372). Freedom from all autograft- and homograft-related reoperations at 120 months was 85.9% +/- 6.3% (SE, 0.0321). Autograft or homograft endocarditis occurred in 8 patients, and 1 patient had simultaneous endocarditis of both valves.
Patient survival and freedom from prostheses-related events over 11 years still compares favorably with conventional heart valve prostheses. Mortality and morbidity remain low. Reoperation for autograft or homograft failure is higher than our previous reports, and endocarditis is also evident, 1.9% (9 of 467). Homograft dysfunction is higher in younger recipients.
尽管罗斯手术需要对主动脉瓣病变进行双瓣膜置换，但它是唯一可用的自体主动脉瓣置换术。我们报告了一个单位11年的经验。
2006年8月之前，467例患者（平均年龄41±15岁；男性358例）接受了罗斯手术。右心室流出道用冷冻保存的同种异体肺动脉瓣修复。随访完成率为94.4%。
30天死亡率为0.6%。120个月时的Kaplan-Meier生存估计值为94.4%±2.9%（标准误[SE]，0.0146）。15例患者（7例修复，8例置换）因自体瓣膜失败而再次手术，120个月时以再次手术或反流超过Ⅱ级衡量的自体瓣膜无失败率为94.2%±2.8%（SE，0.0142）。11例患者进行了同种异体瓣膜置换，主要原因是狭窄。120个月时同种异体瓣膜无功能障碍（定义为同种异体瓣膜再次手术或同种异体瓣膜峰值压差≥30 mmHg）的比例为79.3%±7.3%（SE，0.0372）。120个月时无所有自体瓣膜和同种异体瓣膜相关再次手术的比例为85.9%±6.3%（SE，0.0321）。8例患者发生自体瓣膜或同种异体瓣膜心内膜炎，1例患者同时发生两个瓣膜的心内膜炎。
11年来患者生存率和无人工瓣膜相关事件的情况仍优于传统心脏瓣膜假体。死亡率和发病率仍然较低。自体瓣膜或同种异体瓣膜失败的再次手术率高于我们之前的报告，心内膜炎也很明显，为1.9%（467例中的9例）。年轻受者的同种异体瓣膜功能障碍发生率较高。
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