Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Ann Thorac Surg. 2014 Jan;97(1):182-8. doi: 10.1016/j.athoracsur.2013.08.020. Epub 2013 Oct 8.
The Ross procedure offers several potential advantages in a young patient population. The widespread use of the procedure is still limited due to the technical challenge. Pulmonary homograft stenosis and autograft dilatation remain a matter of concern. We present the long-term outcome in a single center with special emphasis on mortality and need for valvular reintervention.
All patients who received a Ross procedure as freestanding root replacement (modified Yacoub technique) at our institution between 1991 and 2011 were followed. Descriptive statistical methods and Kaplan-Meier analyses were performed.
A total of 246 patients (191 males, 55 females) underwent the Ross procedure during the study period. There were 176 adults and 70 pediatric patients with an average age of 36 ± 10 and 10 ± 5 years, respectively. The median follow-up was 10 years. Twelve (4.9%) subjects were lost to follow-up. Early mortality was 1.6%. Overall mortality was comparable with an age and sex matched population for adult patients. The linearized risk for reoperation per patient-year was 0.6% for the autograft and 0.6% for the right ventricular outflow tract, with a mean time to surgery of 6.4 ± 4.9 years. Overall freedom from reintervention was 95% at 5 years, 88% at 10 years, and 81% at 15 years.
The Ross procedure provides good early results and an excellent long-term survival. It represents an excellent method of aortic valve replacement in children and young adults. Root reinforcement techniques and aortic reduction plasty may be beneficial, especially in adult patients with native aortic valve regurgitation.
在年轻患者群体中，Ross 手术具有多种潜在优势。由于技术挑战，该手术的广泛应用仍然受到限制。肺动脉同种移植物狭窄和自体移植物扩张仍然是一个令人关注的问题。我们在一个中心介绍了该手术的长期结果，特别强调死亡率和瓣膜再次干预的需求。
在我们的机构中，1991 年至 2011 年间，所有接受 Ross 手术作为独立根部置换术（改良 Yacoub 技术）的患者都接受了随访。采用描述性统计方法和 Kaplan-Meier 分析。
在研究期间，共有 246 例患者（191 例男性，55 例女性）接受了 Ross 手术。其中 176 例为成年人，70 例为儿科患者，平均年龄分别为 36 ± 10 岁和 10 ± 5 岁。中位随访时间为 10 年。12 例（4.9%）患者失访。早期死亡率为 1.6%。对于成年患者，总体死亡率与年龄和性别匹配的人群相当。每例患者的自体移植物和右心室流出道再次手术的线性风险分别为 0.6%和 0.6%，平均手术时间为 6.4 ± 4.9 年。5 年、10 年和 15 年时，再次干预的总体无失败率分别为 95%、88%和 81%。
Ross 手术可获得良好的早期结果和优异的长期生存率。它是儿童和年轻成人主动脉瓣置换的一种极好方法。根部强化技术和主动脉缩小整形术可能有益，尤其是在患有原发性主动脉瓣反流的成年患者中。
