The Heart Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Eur J Cardiothorac Surg. 2012 Jul;42(1):25-30; discussion 30-1. doi: 10.1093/ejcts/ezr288. Epub 2012 Jan 20.
The Ross procedure is the preferred aortic valve replacement (AVR) choice in small children. Nonetheless, it is a complicated surgery and there are concerns that subsequent cardiac reoperations are exceptionally complex and associated with high morbidity and mortality. We examine the surgical spectrum and report outcomes of cardiac reoperations in patients who had undergone the Ross procedure during childhood.
Records of 227 consecutive children (<18 years old) who had undergone the Ross procedure at our institution from 1991 to 2004 were reviewed. Our patient cohort was 50 patients who underwent 58 cardiac reoperations following the Ross procedure during the follow-up. Time-related outcomes were analyzed.
From 1992 to 2009, 50 patients, 37 males (74%), underwent cardiac reoperation at a mean age of 15.6±5.2 years and a mean interval of 3.9±3.0 years following the Ross procedure. Risk factors for cardiac reoperation following the Ross procedure on multivariable analysis were rheumatic fever, aortic regurgitation, concomitant cardiac surgery, use of fresh homografts and earlier era of surgery. Overall, 32 (55%) reoperations were isolated procedures whereas 26 (45%) were more complex involving 2-4 simultaneous cardiac procedures. In total, 92 procedures were performed including AVR (n=31), homograft replacement (n=23), mitral valve replacement (n=18), mitral valve repair (n=11), tricuspid valve repair (n=5) and other (n=4). There was no operative mortality and one late death. Survival was 98% at 10 years. During the follow-up, 8 of 50 patients required further cardiac surgery following initial reoperation with freedom from additional cardiac surgery of 82% at 10 years. Subsequent cardiac surgery risk was higher in patients with pre-operative aortic regurgitation and those who had concomitant surgery at time of Ross on log-rank analysis. Among survivors, 96% are in New York Heart Association class I/II.
A wide range of cardiac reoperations may be required in children following the Ross procedure, especially those with underlying rheumatic aetiology, aortic regurgitation and multivalvular involvement. Despite complexity, reoperation following the Ross procedure can be performed with low mortality and good mid-term results. This information should be taken into consideration during the selection of aortic valve substitute in children.
罗斯手术是小儿主动脉瓣置换术（AVR）的首选。尽管如此，这是一种复杂的手术，有人担心随后的心脏再次手术异常复杂，且发病率和死亡率高。我们检查了手术范围，并报告了在儿童时期接受罗斯手术的患者的心脏再次手术的结果。
回顾了 1991 年至 2004 年在我院接受连续 227 例（<18 岁）儿童进行的罗斯手术的记录。我们的患者队列包括 50 名患者，在随访期间接受了 58 例罗斯手术后的心脏再次手术。分析了与时间相关的结果。
1992 年至 2009 年，50 名男性（74%）患者在接受罗斯手术后平均 15.6±5.2 岁和平均 3.9±3.0 年时接受了心脏再次手术。多变量分析显示，风湿热、主动脉瓣反流、同时行心脏手术、使用新鲜同种异体移植物和手术早期是罗斯手术后心脏再次手术的危险因素。总体而言，32 例（55%）再次手术为单纯手术，26 例（45%）更为复杂，涉及 2-4 种同时进行的心脏手术。共进行了 92 次手术，包括主动脉瓣置换术（n=31）、同种异体移植物置换术（n=23）、二尖瓣置换术（n=18）、二尖瓣修复术（n=11）、三尖瓣修复术（n=5）和其他手术（n=4）。无手术死亡，1 例晚期死亡。10 年生存率为 98%。在随访期间，50 例患者中有 8 例在初始再次手术后需要进一步心脏手术，10 年时无额外心脏手术的生存率为 82%。log-rank 分析显示，术前主动脉瓣反流和罗斯手术时同时行其他手术的患者再次心脏手术的风险更高。在幸存者中，96%为纽约心脏协会心功能分级 I/II 级。
罗斯手术后儿童可能需要进行广泛的心脏再次手术，特别是那些有风湿病因、主动脉瓣反流和多瓣膜受累的儿童。尽管手术复杂，但罗斯手术后再次手术死亡率低，中期结果良好。在选择儿童主动脉瓣替代物时应考虑这些信息。
