Xu Zhiwei, Li Wenbin, Xu Xiufang, Zhou Zifan, Song Shiqiu, Ma Jinghui, Zhang Jianqun
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, P. R. China.
Department of Molecular Biology, Institute of Heart, Lung and Blood Vessel, Beijing Anzhen Hospital, Capital Medical University, Beijing, P. R. China.
Thorac Cardiovasc Surg. 2014 Apr;62(3):216-21. doi: 10.1055/s-0032-1311542. Epub 2012 Jul 12.
Although the Ross operation requires double-valve replacement for aortic valve disease, it has been shown to provide excellent hemodynamic results and is associated with low morbidity and mortality rates. We reviewed our long-term experience after completion of the Ross procedure.
Between October 1994 and February 2009, 58 consecutive patients underwent a Ross procedure at our institution. The right ventricular outñow tract was repaired with a cryopreserved pulmonary homograft. All patients were scheduled for a yearly study thereafter that ended at the time of death or at closure of the follow-up visit. Mean follow-up was 8.2 ± 3.5 years (range: 1.8 to 16.2 years).
There were two early deaths (3%) and one late death (2%). Actuarial survival at 16 years was 94.8 ± 3.1%. One patient required reoperation and died during reoperation 1.5 years after his first Ross operation. Of the 55 survival patients, 42 patients (76%) were in NYHA functional class I and 13 patients (24%) were in NYHA functional class II. Grade 1 or grade 2 autograft regurgitation was observed in seven patients (12%) at 1 year after the surgery. The sinus of Valsalva diameters were all <40 mm in these seven patients. Freedom from hemodynamically relevant autograft regurgitation was 88 ± 2.8% at 16 years. After surgery, left ventricular function was significantly improved and left ventricular end-diastolic diameter recovered to normal over the long term. None of the patients required reoperation due to pulmonary homograft failure.
The Ross procedure can be safely performed in patients with aortic valve disease. To date, mortality, morbidity, and reoperation rates are very low. Reasons for these superior results may include the following: (1) the diameter of the aortic valve annulus matching that of the pulmonary valve and (2) patients were monitored with antihypertensive medications to keep systolic blood pressure under 120 mm Hg to delay pressure lesions to the pulmonary autograft.
尽管罗斯手术需要对主动脉瓣疾病进行双瓣膜置换，但已证明其能提供出色的血流动力学结果，且发病率和死亡率较低。我们回顾了完成罗斯手术后的长期经验。
1994年10月至2009年2月期间，我们机构连续58例患者接受了罗斯手术。右心室流出道用冷冻保存的同种异体肺动脉瓣修复。此后所有患者均安排每年进行一次检查，直至死亡或随访结束。平均随访时间为8.2±3.5年（范围：1.8至16.2年）。
有2例早期死亡（3%）和1例晚期死亡（2%）。16年时的精算生存率为94.8±3.1%。1例患者在首次罗斯手术后1.5年需要再次手术，并在再次手术期间死亡。在55例存活患者中，42例（76%）为纽约心脏协会（NYHA）心功能I级，13例（24%）为NYHA心功能II级。术后1年，7例患者（12%）观察到1级或2级自体瓣膜反流。这7例患者的主动脉瓣窦直径均<40mm。16年时无血流动力学相关自体瓣膜反流的发生率为88±2.8%。术后，左心室功能显著改善，左心室舒张末期直径长期恢复正常。没有患者因同种异体肺动脉瓣功能衰竭而需要再次手术。
罗斯手术可安全地应用于主动脉瓣疾病患者。迄今为止，死亡率、发病率和再次手术率都非常低。这些优异结果的原因可能包括：（1）主动脉瓣环直径与肺动脉瓣匹配；（2）对患者使用抗高血压药物进行监测，使收缩压保持在120mmHg以下，以延缓对肺动脉自体瓣膜的压力损伤。
