Schneider Adriaan W, Bökenkamp Regina, Bruggemans Eline F, Hazekamp Mark G
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands.
Eur J Cardiothorac Surg. 2016 Jun;49(6):1564-70. doi: 10.1093/ejcts/ezv434. Epub 2015 Dec 30.
The Ross-Konno procedure is a last resort for patients with complex multilevel left ventricular outflow tract obstruction (LVOTO) often having other cardiovascular anomalies. It is typically preceded by multiple surgeries. Literature is scarce on long-term follow-up series. Therefore, we have reviewed our 20-year experience with this procedure in order to provide insights in patients' outcomes and to optimize patient selection.
Between January 1995 and December 2014, 48 patients underwent the Ross-Konno procedure. The median age at operation was 12.8 months (range, 11 days to 31 years). Twenty-two (46%) patients were under 1 year of age. Forty-four (92%) patients had undergone a total of 82 previous procedures. Eleven (23%) patients had concomitant surgery, predominantly mitral valve (n = 5) and aortic arch surgery (n = 5).
The median follow-up time was 4.3 years (range, 0-20 years). There were 6 (12.5%) early deaths and 4 (8.3%) late deaths. Estimated overall survival at 5, 10 and 15 years was 83, 79 and 70%, respectively. Poor LV function was a risk factor for early mortality (odds ratio = 9.5; 95% confidence interval = 1.4-63.7; P = 0.020). Twelve patients required a total of 29 procedures in 17 reoperations. Five patients required reoperation for autograft failure at a median of 14 years (range, 5-15 years) postoperatively. Estimated freedom from all causes of reoperation at 5, 10 and 15 years was 82, 55 and 30%, respectively. All patients had complete and durable relief of LVOTO. At latest follow-up, 5 patients had a sinus of Valsalva Z-score of 5 or greater. One patient had Grade II autograft insufficiency.
The Ross-Konno procedure is a durable solution for multilevel LVOTO in a highly complex patient population with high incidence of previous procedures. High early mortality rates in patients with impaired left ventricular function emphasize the importance of patient selection. Freedom from reoperation shows a continuous attrition rate. Reoperation for autograft failure may occur late after the Ross-Konno procedure.
罗斯 - 康诺手术是患有复杂多级左心室流出道梗阻（LVOTO）且常伴有其他心血管异常患者的最后手段。该手术通常在多次手术之前进行。关于长期随访系列的文献很少。因此，我们回顾了我们在该手术方面20年的经验，以便深入了解患者的预后并优化患者选择。
1995年1月至2014年12月期间，48例患者接受了罗斯 - 康诺手术。手术时的中位年龄为12.8个月（范围为11天至31岁）。22例（46%）患者年龄小于1岁。44例（92%）患者此前共接受过82次手术。11例（23%）患者接受了同期手术，主要是二尖瓣手术（n = 5）和主动脉弓手术（n = 5）。
中位随访时间为4.3年（范围为0至20年）。有6例（12.5%）早期死亡和4例（8.3%）晚期死亡。5年、10年和15年的估计总生存率分别为83%、79%和70%。左心室功能差是早期死亡的危险因素（比值比 = 9.5；95%置信区间 = 1.4 - 63.7；P = 0.020）。12例患者在17次再次手术中共需要29次手术。5例患者在术后中位时间14年（范围为5至15年）因自体移植物失败需要再次手术。5年、10年和15年估计无再次手术的所有原因的概率分别为82%、55%和30%。所有患者的LVOTO均得到完全且持久的缓解。在最近一次随访时，5例患者的主动脉瓣窦Z值为5或更高。1例患者有Ⅱ级自体移植物功能不全。
罗斯 - 康诺手术是治疗高度复杂且既往手术发生率高患者群体中多级LVOTO的持久解决方案。左心室功能受损患者的早期死亡率高强调了患者选择的重要性。无再次手术显示出持续的损耗率。罗斯 - 康诺手术后自体移植物失败的再次手术可能发生在晚期。
