Section of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Eur J Cardiothorac Surg. 2010 May;37(5):1002-7. doi: 10.1016/j.ejcts.2009.12.012. Epub 2010 Feb 6.
Aortic root dilatation with and without aortic regurgitation is seen in up to 20% of patients undergoing a Ross aortic root replacement at late follow-up. We present our early experience with reduction annuloplasty combined with prosthetic Dacron graft replacement of the aorta above the autograft to prevent late dilation after a Ross aortic root replacement.
Since 2001, 31 of 97 adult and paediatric patients (mean age 28.8+/-14.4 years; range 8-53 years) with bicuspid aortic valve and dilatation of the ascending aorta underwent a modified Ross procedure with reduction annuloplasty combined with prosthetic Dacron graft replacement of the ascending aorta. The diameter of the ascending aorta was measured before and early after surgery and then between 3 months and 8 years' follow-up (mean, 2.5+/-2.2 years).
There were no early or late deaths. Reduction annuloplasty combined with ascending aortic graft replacement decreased the diameters of the ascending aorta from 42+/-7.0mm preoperatively to 25+/-2.9 mm early after surgery (p<0.001). During follow-up, there was no significant increase of the aortic diameter compared with that during the postoperative period (27+/-4.3mm; p=0.07). The root diameter increased in only 3 of 31 patients (10%). No patient underwent re-operation. At last follow-up, mild (n=18) or trivial (n=13) aortic regurgitation was observed.
Ross aortic root replacement combined with reduction annuloplasty and Dacron graft replacement of the ascending aorta demonstrated excellent early- to mid-term results in patients with bicuspid aortic valve and dilatation of the ascending aorta. Continued use and long-term follow-up imaging is necessary to further demonstrate the value of this technical modification.
在接受罗斯主动脉根部置换术的患者中，多达 20%的患者在晚期随访时出现主动脉根部扩张伴或不伴主动脉瓣关闭不全。我们介绍了我们在罗斯主动脉根部置换术后使用主动脉瓣环成形术联合人造涤纶移植物置换主动脉瓣上方主动脉以预防晚期扩张的早期经验。
自 2001 年以来，31 例成人和儿童患者（平均年龄 28.8+/-14.4 岁；年龄 8-53 岁），主动脉瓣二叶畸形伴升主动脉扩张，接受改良的罗斯手术，主动脉瓣环成形术联合人造涤纶移植物置换升主动脉。在术前、术后早期及术后 3 个月至 8 年随访期间（平均 2.5+/-2.2 年）测量升主动脉直径。
无早期或晚期死亡。主动脉瓣环成形术联合升主动脉移植物置换术使升主动脉直径从术前的 42+/-7.0mm 减小至术后早期的 25+/-2.9mm（p<0.001）。随访期间，与术后期间相比，主动脉直径无明显增加（27+/-4.3mm；p=0.07）。在 31 例患者中，仅 3 例（10%）根部直径增加。无患者再次手术。最后一次随访时，观察到轻度（n=18）或轻微（n=13）主动脉瓣关闭不全。
在主动脉瓣二叶畸形伴升主动脉扩张的患者中，罗斯主动脉根部置换术联合主动脉瓣环成形术和人造涤纶移植物置换升主动脉术取得了优异的早期至中期结果。需要继续使用和长期随访影像学检查来进一步证明这种技术改良的价值。
