Department of Cardiothoracic Surgery, University Hospital Lund, Lund, Sweden.
Eur J Cardiothorac Surg. 2010 Apr;37(4):928-33. doi: 10.1016/j.ejcts.2009.11.008. Epub 2009 Dec 16.
Following the Ross operation, pulmonary autografts tend to dilate over time. This study researches the fate of the pulmonary autograft - at 4.5 years following the modified Ross operation - with special reference to the impact of the modification on (a) pulmonary autograft dilatation, (b) the neo-aortic root geometry, (c) neo-aortic valve function and (d) the coronary artery reserve.
A total of 26 patients who underwent the Ross operation were included in this study; of these, 13 consecutive patients underwent a modified Ross operation in which the free-standing autograft root was supported externally by a Dacron vascular prosthetic jacket (DVPJ). These patients were compared to a cohort of 13 matched patients who were operated on using the conventional Ross technique; all patients were followed up prospectively by echocardiography studies. The patients who underwent the modified Ross operation were also subjected to bicycle ergometry.
At the 47-month median follow-up, there was no significant increase in the size of the entire neo-aortic root in the patients who underwent the modified Ross operation; in addition, the geometry of the neo-aortic root was also preserved and the left ventricular function had improved significantly, whilst the aortic valve function and excursion remained satisfactory. All patients, with one exception, in the modified Ross operation group exhibited normal exercise capacity. By contrast, there were significant differences in diameters of the aortic root - between the two surgical techniques in favour of the modified Ross technique - following a median follow-up of 23 months in the patients subjected to the conventional Ross operation.
Provision of external support to the entire pulmonary autograft with a DVPJ prevents its dilatation following free-standing pulmonary autograft Ross operation when evaluated at the 4.5-year follow-up. The function and the geometry of the neo-aortic root are not affected negatively by this modification and the patients demonstrated normal exercise capacity.
在 Ross 手术后，肺自体移植物随着时间的推移会扩张。本研究研究了改良 Ross 手术后 4.5 年的肺自体移植物的命运，特别关注（a）肺自体移植物扩张、（b）新主动脉根部几何形状、（c）新主动脉瓣功能和（d）冠状动脉储备的影响。
本研究共纳入 26 例接受 Ross 手术的患者；其中，13 例连续患者接受改良 Ross 手术，其中独立的自体移植物根部由涤纶血管假体套（DVPJ）外部支撑。这些患者与接受传统 Ross 技术手术的 13 例匹配患者进行比较；所有患者均通过超声心动图研究进行前瞻性随访。接受改良 Ross 手术的患者还接受了自行车测力计检查。
在 47 个月的中位随访中，接受改良 Ross 手术的患者整个新主动脉根部大小没有明显增加；此外，新主动脉根部的几何形状也得到了保留，左心室功能显著改善，而主动脉瓣功能和活动度保持满意。改良 Ross 手术组的所有患者（除 1 例外）均表现出正常的运动能力。相比之下，在接受传统 Ross 手术的患者中，两种手术技术之间的主动脉根部直径存在显著差异，有利于改良 Ross 技术，在中位随访 23 个月后。
用 DVPJ 为独立的肺自体移植物提供整个肺自体移植物的外部支撑，可以防止在改良 Ross 手术后 4.5 年的随访中发生扩张。新主动脉根部的功能和几何形状不受此修改的负面影响，患者表现出正常的运动能力。
