University of Luebeck, Luebeck, Germany.
J Thorac Cardiovasc Surg. 2012 Oct;144(4):813-21; discussion 821-3. doi: 10.1016/j.jtcvs.2012.07.005. Epub 2012 Aug 9.
Reinterventions after the Ross procedure are a concern for patients and treating physicians. The scope of the present report was to provide an update on the reinterventions observed in the large patient population of the German-Dutch Ross Registry.
From 1988 to 2011, 2023 patients (age, 39.05 ± 16.5 years; male patients, 1502; adults, 1642) underwent a Ross procedure in 13 centers. The mean follow-up was 7.1 ± 4.6 years (range, 0-22 years; 13,168 patient-years).
In the adult population, 120 autograft reinterventions in 113 patients (1.03%/patient-year) and 76 homograft reinterventions in 67 patients (0.65%/patient-year) and, in the pediatric population, 14 autograft reinterventions in 13 patients (0.91%/patient-year) and 42 homograft reinterventions in 31 patients (2.72%/patient-year) were observed. Of the autograft and homograft reinterventions, 17.9% and 21.2% were performed because of endocarditis, respectively. The subcoronary technique in the adult population resulted in significantly superior autograft durability (freedom from autograft reintervention: 97% at 10 years and 91% at 12 years; P < .001). The root replacement technique without root reinforcement (hazard ratio, 2.4; 95% confidence interval, 1.4-4.1) and the presence of pure aortic insufficiency preoperatively (hazard ratio, 2.3; 95% confidence interval, 1.5-3.5) were statistically significant predictors for a shorter time to reoperation. The center volume had a significant influence on the long-term results. The freedom from homograft reoperation for the adults and pediatric population was 97% and 87% at 5 years and 93% and 79% at 12 years, respectively (P < .001), with younger recipient and donor age being significant predictors of a shorter time to homograft reoperation.
The autograft principle remains a valid option for young patients requiring aortic valve replacement. The risk of reoperation depends largely on the surgical technique used and the preoperative hemodynamics. Center experience and expertise also influence the long-term results. Adequate endocarditis prophylaxis might further reduce the need for reoperation.
罗斯手术（Ross procedure）后的再次介入是患者和治疗医生关注的问题。本报告的目的是提供德国-荷兰罗斯登记处大型患者人群中观察到的再次介入更新情况。
1988 年至 2011 年，13 个中心的 2023 名患者（年龄 39.05±16.5 岁；男性患者 1502 名；成人患者 1642 名）接受了罗斯手术。平均随访时间为 7.1±4.6 年（范围 0-22 年；13168 患者年）。
在成人患者中，113 名患者中有 120 次自体移植物再次介入（1.03%/患者年），67 名患者中有 76 次同种异体移植物再次介入（0.65%/患者年），在儿科患者中，13 名患者中有 14 次自体移植物再次介入（0.91%/患者年），31 名患者中有 42 次同种异体移植物再次介入（2.72%/患者年）。自体移植物和同种异体移植物再次介入中，分别有 17.9%和 21.2%是由于心内膜炎所致。在成人人群中，主动脉瓣下技术显著提高了自体移植物的耐久性（无自体移植物再次介入的生存率：10 年时为 97%，12 年时为 91%；P<0.001）。无根强化的根部置换技术（危险比，2.4；95%置信区间，1.4-4.1）和术前存在单纯主动脉瓣关闭不全（危险比，2.3；95%置信区间，1.5-3.5）是再次手术时间较短的统计学显著预测因素。中心容量对长期结果有显著影响。成人和儿科患者的同种异体移植物无再手术生存率分别为 5 年时的 97%和 87%，12 年时的 93%和 79%（P<0.001），受体和供体年龄较小是同种异体移植物再手术时间较短的显著预测因素。
对于需要主动脉瓣置换的年轻患者，自体移植物原则仍然是一个有效的选择。再次手术的风险在很大程度上取决于所使用的手术技术和术前血液动力学。中心经验和专业知识也会影响长期结果。适当的心内膜炎预防措施可能进一步减少再次手术的需要。
