Department of Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, Lille, France.
Ann Thorac Surg. 2012 Feb;93(2):598-604; discussion 605. doi: 10.1016/j.athoracsur.2011.06.083. Epub 2011 Oct 8.
The risk of reoperation on the autograft and homograft is the major long-term drawback of the Ross procedure. The incidence and clinical implications of reoperations after the Ross procedure are reported.
Between March 1992 and February 2010, 336 consecutive patients had a Ross procedure (mean follow-up, 6.2±4.9 years). Autograft implant technique was freestanding root replacement in 269 patients, subcoronary implantation in 52 patients and a modified root replacement with the autograft included in a Valsalva tube graft in 15.
Subsequently, 38 patients (11.3%) underwent reoperations, for autograft dilatation in 23 and a significant autograft insufficiency in 9, at 9.6±3.7 years and 2.6±3.9 years, respectively. Aortic and pulmonary infective endocarditis occurred in 3 patients. Three patients underwent a non valve-related cardiac reoperation. Three patients received a transcatheter pulmonary valve implantation after 12.2±1.7 years. At 15 years, freedoms for autograft and homograft explantation (with 95% confidence interval) were 83.3% (77.4%- to 9.2%) and 92.8% (87.6% to 97.9%), respectively. Native aortic valve regurgitation, indexed aortic annulus diameter exceeding 1.35 cm/m2 and autograft diameter were risk factors for dilated autograft reoperation (hazard ratio, 3.23 [95% confidence interval, 1.19 to 8.81], p=0.02; 3.83 [0.9 to 16.33], p=0.07 and 1.2 per mm [1.01 to 1.41], p=0.03), respectively.
Autograft dilatation was the leading cause of reoperation in patients who underwent root replacement. Long-term follow-up is mandatory to determine whether modifications of the operative technique could limit autograft dilatation.
自体移植物和同种异体移植物的再手术风险是 Ross 手术的主要长期缺点。本文报告了 Ross 手术后再次手术的发生率和临床意义。
1992 年 3 月至 2010 年 2 月，336 例连续患者接受了 Ross 手术（平均随访 6.2±4.9 年）。自体移植物植入技术在 269 例患者中为游离根置换，在 52 例患者中为冠状动脉下植入，在 15 例患者中为改良根置换，自体移植物包含在 Valsalva 管状移植物中。
随后，38 例患者（11.3%）接受了再次手术，其中 23 例为自体移植物扩张，9 例为明显的自体移植物功能不全，分别在 9.6±3.7 年和 2.6±3.9 年。3 例患者发生主动脉和肺动脉感染性心内膜炎。3 例患者进行了非瓣膜相关的心脏再次手术。3 例患者在 12.2±1.7 年后接受了经导管肺动脉瓣植入术。15 年时，自体移植物和同种异体移植物取出（95%置信区间）的自由度分别为 83.3%（77.4%至 9.2%）和 92.8%（87.6%至 97.9%）。原生主动脉瓣反流、索引主动脉瓣环直径超过 1.35cm/m2 和自体移植物直径是自体移植物扩张再手术的危险因素（风险比，3.23[95%置信区间，1.19 至 8.81]，p=0.02；3.83[0.9 至 16.33]，p=0.07 和 1.2mm[1.01 至 1.41]，p=0.03）。
自体移植物扩张是接受根置换术的患者再次手术的主要原因。需要长期随访以确定手术技术的改进是否可以限制自体移植物扩张。
