Department of Surgery, University of Colorado, Denver, Colorado.
Division of Cardiothoracic Surgery, Oregon Health Sciences Center, Portland, Oregon.
Ann Thorac Surg. 2014 Jan;97(1):175-81. doi: 10.1016/j.athoracsur.2013.07.036. Epub 2013 Sep 23.
Although questionable durability has tempered enthusiasm for the Ross procedure in the last decade, the perioperative risks of the Ross procedure relative to conventional aortic valve replacement are not well described. The goal of this study is to describe both the perioperative outcomes and utilization trends of the Ross procedure in adults in The Society of Thoracic Surgeons Adult Cardiac Surgery Database.
The Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to review all Ross procedures performed between 1994 and 2010. The utilization of the procedure in the database was assessed. Then the preoperative comorbidities, patient demographics, and risk factors were reviewed, as were intraoperative and perioperative outcomes.
Of 648,541 aortic valve replacements during the study period, 3,054 (0.47%) were identified as Ross procedures. Utilization of the procedures as a percent of total aortic valve replacements peaked in 1998 at 1.2%, followed by a steady decline to 0.09% by 2010. More than a quarter of all Ross operations were performed at six sites. Using propensity-matching analyses, Ross patients experienced significantly more perioperative complications including reexploration (9.4% versus 5.8%; p < 0.01), renal failure (2.6% versus 0.8%; p < 0.001), and operative mortality (2.7% versus 0.9%; p = 0.001).
These data suggest that the Ross procedure is associated with greater perioperative morbidity and mortality risks compared with conventional aortic valve replacement. Recognition of these risks along with durability concerns have resulted in a dramatic decline in the number of Ross procedures performed in North America in the last decade.
尽管罗斯手术（Ross procedure）在过去十年中因耐久性问题而受到质疑，但该手术与传统主动脉瓣置换术相比的围手术期风险尚未得到充分描述。本研究旨在描述罗斯手术在胸外科医师学会（STS）成人心脏手术数据库中成人患者中的围手术期结果和应用趋势。
使用 STS 成人心脏手术数据库回顾 1994 年至 2010 年间所有实施的罗斯手术。评估该手术在数据库中的应用情况。然后回顾术前合并症、患者人口统计学特征和危险因素，以及术中及围手术期结果。
在研究期间的 648541 例主动脉瓣置换术中，有 3054 例（0.47%）被确定为罗斯手术。该手术的应用百分比在 1998 年达到峰值（1.2%），随后稳定下降至 2010 年的 0.09%。所有罗斯手术中有超过四分之一是在六个地点进行的。使用倾向评分匹配分析，罗斯组患者经历更多围手术期并发症，包括再次探查（9.4%比 5.8%；p < 0.01）、肾衰竭（2.6%比 0.8%；p < 0.001）和手术死亡率（2.7%比 0.9%；p = 0.001）。
这些数据表明，与传统主动脉瓣置换术相比，罗斯手术与更大的围手术期发病率和死亡率风险相关。对这些风险的认识以及耐久性问题的担忧导致在过去十年中，北美实施罗斯手术的数量大幅下降。
