Department of Cardiovascular Surgery and Anesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Thorac Cardiovasc Surg. 2011 Sep;142(3):634-40, 640.e1. doi: 10.1016/j.jtcvs.2010.11.025. Epub 2011 Feb 1.
Dilatation of the pulmonary autograft has been observed after the Ross procedure. Whether the remaining native aorta dilates is not known. The aim of the study was to describe the prevalence and severity of autograft and native aortic dilatation over time and to identify possible determinants.
Ninety-one adult patients underwent the Ross procedure with the full root replacement technique. In 31 (34%) patients, the ascending aorta was downsized during surgical intervention. A baseline postoperative echocardiographic investigation was performed. A comprehensive investigation of the aorta from the annulus to the proximal descending aorta was performed (n = 71) after a median follow-up of 8.9 years. An intermediate investigation was performed (n = 29) after a median of 7.6 years. Autograft and native aortic dimensions were compared over time and with those of a control group (n = 38). For each patient in the study group, the expected aortic dimensions were predicted based on findings in the control group. Enlargement was defined as a z score of greater than 1.96 from the predicted value.
The autograft and native aortic dimensions increased significantly from baseline to the intermediate follow-up and continued to increase to the final follow-up. The proportion of patients with enlarged autografts and proximal ascending aortas was 13% and 16% at baseline, increasing to 33% (P = .006) and 44% (P = .0014), respectively, at the end of follow-up. Enlargement of the aorta at the final follow-up was related to larger baseline pulmonary autograft dimensions but not to native bicuspid valve or the need to downsize the aortic root.
Pulmonary autograft dilatation is common after the Ross procedure in adults. The dilatation progresses over time and is often accompanied by dilatation of the native aorta.
Ross 手术后观察到肺动脉移植物扩张。但剩余的原生主动脉是否扩张尚不清楚。本研究旨在描述随时间推移自体移植物和原生主动脉扩张的发生率和严重程度，并确定可能的决定因素。
91 例成人接受了全窦置换技术的 Ross 手术。31 例（34%）患者在手术干预期间进行了升主动脉缩窄。术后进行基线超声心动图检查。在中位随访 8.9 年后，对 71 例患者的主动脉瓣环至近端降主动脉进行了全面检查。在中位随访 7.6 年后进行了中间检查（n=29）。随时间推移比较自体移植物和原生主动脉的尺寸，并与对照组（n=38）进行比较。对于研究组中的每位患者，根据对照组的发现预测预期的主动脉尺寸。扩张定义为预测值的 z 分数大于 1.96。
自基线至中期随访，自体移植物和原生主动脉尺寸显著增加，并持续增加至最终随访。基线时，自体移植物和近端升主动脉增大的患者比例分别为 13%和 16%，随访结束时分别增至 33%（P=0.006）和 44%（P=0.0014）。最终随访时主动脉扩张与较大的基线肺动脉移植物尺寸相关，但与原生二叶瓣或需要缩小主动脉根部无关。
Ross 手术后成人肺动脉移植物扩张很常见。扩张随时间推移而进展，常伴有原生主动脉扩张。
