Raja Shahzad G, Atamanyuk Iryna, Kostolny Martin, Tsang Victor
Department of Paediatric Cardiothoracic Surgery, Great Ormond Street Hospital, London WC1N 3JH, UK.
Interact Cardiovasc Thorac Surg. 2010 Apr;10(4):600-4. doi: 10.1510/icvts.2009.229534. Epub 2010 Jan 26.
A best evidence topic in cardiac surgery was written, according to a structured protocol. The question addressed was: in young patients with rheumatic aortic regurgitation compared to non-rheumatics is a Ross operation associated with increased incidence of autograft failure? The pulmonary autograft with its inherent advantages of viable autologous transplant, central laminar flow, freedom from prosthetic valve complications, side effects of anticoagulation, and growth potential is considered a well-accepted option for aortic valve replacement in young patients. However, the use of a pulmonary autograft in young patients with rheumatic aortic valve disease is controversial. We analyse existing evidence to determine the suitability of the pulmonary autograft as a substitute for the diseased aortic valve in patients with rheumatic disease. Altogether 901 papers were found using the reported search terms, from which eight represented the best evidence to answer the clinical question. In addition, a meta-analysis also superficially addressed this issue. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All eight publications were from two institutions with one reporting outcomes for a Ross operation vs. mechanical valve implantation and two compared results of the Ross operation in rheumatic vs. non-rheumatic aortic valve disease. We conclude that the current available evidence suggests that pulmonary autograft is susceptible to rheumatic involvement. Use of pulmonary autograft in young patients (<30 years) with rheumatic aortic regurgitation and concomitant mitral regurgitation requires a cautious approach as there is an impaired autograft durability in this subgroup of patients.
按照结构化方案撰写了一篇心脏外科的最佳证据主题文章。所探讨的问题是：与非风湿性患者相比，年轻的风湿性主动脉瓣反流患者进行罗斯手术是否会增加自体移植物失败的发生率？肺动脉自体移植物具有自体移植存活、中心层流、无人工瓣膜并发症、无需抗凝副作用以及具有生长潜力等固有优势，被认为是年轻患者主动脉瓣置换的一个广泛接受的选择。然而，在患有风湿性主动脉瓣疾病的年轻患者中使用肺动脉自体移植物存在争议。我们分析现有证据，以确定肺动脉自体移植物作为风湿性疾病患者病变主动脉瓣替代品的适用性。使用报告的检索词共找到901篇论文，其中8篇代表了回答该临床问题的最佳证据。此外，一项荟萃分析也初步探讨了这个问题。将这些论文的作者、期刊、出版日期和国家、研究的患者组、研究类型、相关结果和结果制成表格。所有8篇出版物均来自两个机构，其中一篇报告了罗斯手术与机械瓣膜植入的结果，两篇比较了风湿性与非风湿性主动脉瓣疾病中罗斯手术的结果。我们得出结论，目前可得的证据表明肺动脉自体移植物易受风湿累及。在患有风湿性主动脉瓣反流且伴有二尖瓣反流的年轻患者（<30岁）中使用肺动脉自体移植物需要谨慎，因为该亚组患者的自体移植物耐久性受损。
