Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
J Thorac Cardiovasc Surg. 2013 Feb;145(2):430-437.e1; discussion 436-7. doi: 10.1016/j.jtcvs.2012.07.004. Epub 2012 Nov 14.
In children with aortic valve disease associated with annular hypoplasia or complex multilevel left ventricular outflow tract obstruction, the Ross procedure, combined with a modified Konno-type aortoventriculoplasty, is advocated. We aim to examine the fate of the neoaortic apparatus and assess neoaortic valve function after the modified Ross-Konno procedure.
Forty-three patients, with a median age of 6 years, underwent the modified Ross-Konno procedure with a myectomy but without the use of a ventricular septal patch. Serial postoperative echocardiograms (n = 187) were analyzed, and regression models adjusted for repeated measures were used to model the longitudinal growth of the neoaortic annulus and root.
There were 2 operative deaths (5%) and 1 late mortality. At 8 years, survival was 93% and freedom from autograft, homograft, and all-cause reoperation was 100%, 81%, and 72%, respectively. The median postprocedure diameter and z score were 14 mm (7-21 mm) and +1.3 (-3.0 to +6.1) for the neoaortic annulus and 21 mm (9-30 mm) and +1.6 (-1.3 to +4.1) for the neoaortic root, respectively. Serial echocardiograms showed a progressive increase in annular (+0.56 mm/year, P < .001) and root (+0.89 mm/year, P < .001) diameters but little change in annular (-0.07/year, P = .08) and root (-0.002/year, P = .96) z scores. Autograft regurgitation developed in 9 patients; however, the degree and progression of regurgitation over time were not significant (P = .22).
After the modified Ross-Konno procedure, the neoaortic annulus and root increased in size proportionately to somatic growth. Autograft regurgitation, usually mild and stable, developed in few patients, and none required autograft reoperation. Our findings support the use of the modified Ross-Konno as the procedure of choice in children with aortic valve disease and complex left ventricular outflow tract obstruction.
对于伴有瓣环发育不良或复杂左心室流出道梗阻的主动脉瓣疾病患儿，提倡行 Ross 手术，并结合改良 Konno 型主动脉瓣成形术。我们旨在研究新主动脉瓣装置的命运，并评估改良 Ross-Konno 手术后新主动脉瓣的功能。
43 名中位年龄为 6 岁的患儿接受了改良 Ross-Konno 手术，包括心肌切除术，但未使用室间隔补片。对 187 次术后系列超声心动图进行分析，并使用重复测量调整的回归模型来对新主动脉瓣环和根部的纵向生长进行建模。
有 2 例手术死亡（5%）和 1 例晚期死亡。8 年后，存活率为 93%，自体移植物、同种异体移植物和全因再次手术的无失败率分别为 100%、81%和 72%。新主动脉瓣环的术后中位直径和 z 评分分别为 14mm（7-21mm）和+1.3（-3.0 至+6.1），新主动脉根部的术后中位直径和 z 评分分别为 21mm（9-30mm）和+1.6（-1.3 至+4.1）。系列超声心动图显示瓣环（+0.56mm/年，P<0.001）和根部（+0.89mm/年，P<0.001）直径逐渐增大，但瓣环（-0.07/年，P=0.08）和根部（-0.002/年，P=0.96）z 评分几乎没有变化。9 例患者出现自体移植物反流，但反流程度和随时间的进展无显著差异（P=0.22）。
行改良 Ross-Konno 手术后，新主动脉瓣环和根部与体表面积成比例地增大。自体移植物反流通常较轻且稳定，少数患者出现，但均无需再次行自体移植物手术。我们的发现支持在患有主动脉瓣疾病和复杂左心室流出道梗阻的儿童中使用改良 Ross-Konno 作为首选手术方法。
