Andreas Martin, Wiedemann Dominik, Seebacher Gernot, Rath Claus, Aref Tandis, Rosenhek Raphael, Heinze Georg, Eigenbauer Ernst, Simon Paul, Ruetzler Kurt, Hiesmayr Joerg-Michael, Moritz Anton, Laufer Guenther, Kocher Alfred
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Eur J Cardiothorac Surg. 2014 Sep;46(3):409-13; discussion 413-4. doi: 10.1093/ejcts/ezt663. Epub 2014 Feb 4.
The ideal prosthesis for young patients requiring aortic valve replacement has not been defined to date. Although the Ross procedure provides excellent survival, its application is still limited. We compared the long-term survival after the Ross procedure with mechanical aortic valve replacement.
All consecutive Ross procedures and mechanical aortic valve replacements performed between 1991 and 2008 at a single centre were analysed. Only adult patients between 18 and 50 years of age were included in the study. Survival and valve-related complications were evaluated. Furthermore, survival was compared with the age- and sex-matched Austrian population.
A total of 159 Ross patients and 173 mechanical valve patients were included. The cumulative survival for the Ross procedure was significantly better, with survival rates of 96, 94 and 93% at 5, 10 and 15 years, respectively, in comparison to 90, 84 and 75% (P < 0.01) for patients with mechanical valves. A Cox regression analysis including patients' age, gender and valve type revealed age and the type of aortic valve replacement as independent significant factors influencing survival (for age, hazard ratio = 1.1, 95% confidence interval = 1.0-1.1, P = 0.03; and for valve type, hazard ratio = 2.6, 95% confidence interval = 1.2-5.8, P = 0.02). The observed survival was comparable to the expected standard survival for the Ross group but was significantly reduced in the mechanical valve group.
In a real-world setting, the Ross procedure is associated with a long-term survival benefit in young adults in comparison to mechanical aortic valve replacement.
迄今为止，尚未确定适合需要主动脉瓣置换的年轻患者的理想假体。尽管罗斯手术提供了出色的生存率，但其应用仍然有限。我们比较了罗斯手术后与机械主动脉瓣置换后的长期生存率。
分析了1991年至2008年在单一中心进行的所有连续罗斯手术和机械主动脉瓣置换术。研究仅纳入18至50岁的成年患者。评估生存率和瓣膜相关并发症。此外，将生存率与年龄和性别匹配的奥地利人群进行比较。
共纳入159例罗斯手术患者和173例机械瓣膜患者。罗斯手术的累积生存率明显更高，5年、10年和15年的生存率分别为96%、94%和93%，而机械瓣膜患者的生存率分别为90%、84%和75%（P<0.01）。一项包括患者年龄、性别和瓣膜类型的Cox回归分析显示，年龄和主动脉瓣置换类型是影响生存的独立显著因素（年龄的风险比=1.1，95%置信区间=1.0-1.1，P=0.03；瓣膜类型的风险比=2.6，95%置信区间=1.2-5.8，P=0.02）。观察到的生存率与罗斯组的预期标准生存率相当，但在机械瓣膜组中显著降低。
在实际应用中，与机械主动脉瓣置换相比，罗斯手术对年轻人具有长期生存益处。
