Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia; Department of Cardiothoracic Surgery, Epworth Hospital, Melbourne, Australia; Department of Surgery, University of Melbourne, Parkville, Australia.
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Thorac Cardiovasc Surg. 2015 Feb;149(2 Suppl):S46-52. doi: 10.1016/j.jtcvs.2014.08.068. Epub 2014 Sep 17.
It is hypothesized that by performing radical aortic root manipulation and then autologous support for the pulmonary autograft in the Ross procedure, this will maintain aortic root size and should, in turn, lead to the demonstrated low incidence of late aortic regurgitation and need for reoperation on the aortic root and valve.
Aortic root size was measured echocardiographically both preoperatively and then at second yearly intervals in 322 consecutive patients who underwent a Ross operation between October 1992 and June 2013 with autologous support of the pulmonary autograft root using the patient's own aorta. This technique, a variant of the inclusion cylinder method, has been developed with the aim of minimizing prosthetic materials in the aortic root.
Measures to reduce aortic root size included annulus reduction in 201 patients (62.4%) and reduction in aortic sinus or sinotubular junction in 159 patients (49.4%). Maximal aortic root diameter postoperatively at 5, 10, and 15 years was 34.0, 34.6, and 34.7 mm, respectively. Eleven reoperations were required during the study period for progressive aortic regurgitation (none for aortic root enlargement), with freedom from reoperation being 96% at both 15 years and 18 years. Preoperative pure aortic regurgitation, aortic annulus, and sinotubular junction enlargement were risk factors for reoperation.
This inclusion method of pulmonary autograft implantation leads to minimal increases in aortic root size over time, with no reoperations for aortic root dilatation and a low requirement for aortic valve reoperation. The Ross procedure deserves to remain on the surgical menu for aortic valve replacement.
假设在 Ross 手术中进行激进的主动脉根部操作，然后用自体组织支撑肺动脉移植物，这将维持主动脉根部大小，并应相应导致晚期主动脉瓣反流和主动脉根部及瓣需要再次手术的发生率较低。
在 1992 年 10 月至 2013 年 6 月期间，连续 322 例患者接受了 Ross 手术，用患者自身的主动脉对肺动脉移植物根部进行自体支撑，在术前和术后每两年进行一次超声心动图测量主动脉根部大小。该技术是一种包含圆柱体方法的变体，旨在最小化主动脉根部的人工材料。
减少主动脉根部大小的措施包括 201 例患者（62.4%）的瓣环缩小和 159 例患者（49.4%）的主动脉窦或窦管交界处缩小。术后 5、10 和 15 年的最大主动脉根部直径分别为 34.0、34.6 和 34.7 毫米。在研究期间，11 例患者因进展性主动脉瓣反流需要再次手术（无主动脉根部扩大），15 年和 18 年时无再次手术的比例分别为 96%。术前单纯主动脉瓣反流、主动脉瓣环和窦管交界处增大是再次手术的危险因素。
这种肺动脉移植物植入的包含方法导致主动脉根部大小随时间的推移而最小化增加，没有因主动脉根部扩张而再次手术，主动脉瓣再次手术的需求也较低。Ross 手术仍然是主动脉瓣置换手术的首选。
