Children's Hospital of Illinois, OSF Saint Francis Medical Center, and University of Illinois College of Medicine at Peoria, Peoria, Illinois.
Children's Hospital of Illinois, OSF Saint Francis Medical Center, and University of Illinois College of Medicine at Peoria, Peoria, Illinois.
Ann Thorac Surg. 2014 Jul;98(1):112-8. doi: 10.1016/j.athoracsur.2014.02.038. Epub 2014 Apr 12.
Autograft dilatation (AD) and aortic insufficiency (AI) after the Ross procedure are the most common causes of late autograft failure. The purpose of this study was to examine the results of valve-sparing root replacement (modified David) and composite root replacement.
We performed a retrospective review of all children (n=78) undergoing a Ross procedure at our Center from 1993 to 2011.
Median follow-up was 10 years (1to 18 years). Freedom from autograft reoperation was 94% at 5 years, and 65% at 15 years. Freedom from greater than 2+ autograft AI was 93% at 5 years and 76% at 15 years. Autograft reoperation was necessary in 22 patients, at a median interval of 8.7 years after the original procedure. Indications for reoperation were AI with autograft dilatation in 15 patients, AI without dilatation in 2 patients, and AD without AI in 5 patients. Surgical procedures used at reoperation included valve-sparing root replacement in 14 patients, root replacement either mechanical or biologic valved conduit in 6 patients, and valve replacement in 2 patients. At a mean follow-up of 5.8 years after reoperation, 4 patients from the valve-sparing group underwent second reoperation (valve replacement). Freedom from second autograft reoperation was 71% for patients after a valve sparing procedure and 100% for patients after an aortic valve or root replacement (Bentall procedure) at 5 years.
Autograft valve-sparing root replacement and composite aortic root replacement are effective treatments for aortic root dilation and AI after the Ross procedure. The potential of late autograft insufficiency after valve-sparing root replacement warrants annual follow-up.
Ross 手术后自体移植物扩张（AD）和主动脉瓣关闭不全（AI）是自体移植物晚期衰竭最常见的原因。本研究旨在探讨保留瓣膜的根部置换术（改良 David 术）和复合根部置换术的结果。
我们回顾性分析了 1993 年至 2011 年在我中心行 Ross 手术的所有患儿（n=78）的资料。
中位随访时间为 10 年（1 至 18 年）。5 年时，自体移植物再次手术的无失败率为 94%，15 年时为 65%。5 年时，大于 2+级自体 AI 的无失败率为 93%，15 年时为 76%。22 例患者需要再次手术，中位时间为首次手术后 8.7 年。再次手术的指征为 15 例患者因自体 AI 伴移植物扩张，2 例患者因自体 AI 不伴扩张，5 例患者因 AD 不伴 AI。再次手术时采用的手术方式包括 14 例保留瓣膜的根部置换术，6 例根部置换术（机械或生物瓣带瓣管道）和 2 例瓣膜置换术。再次手术后的平均随访时间为 5.8 年，4 例保留瓣膜组患者再次行第二次手术（瓣膜置换术）。5 年时，行保留瓣膜术的患者再次自体移植物手术的无失败率为 71%，行主动脉瓣或根部置换术（Bentall 术）的患者为 100%。
Ross 手术后自体移植物保留瓣膜的根部置换术和复合主动脉根部置换术是治疗自体移植物扩张和 AI 的有效方法。保留瓣膜的根部置换术后晚期自体移植物功能不全的可能性需要每年随访。
