Karaskov A M, Bogachev-Prokofiev A V, Sharifulin R M, Demin I I, Zheleznev S I, Open A B, Pivkin A N
Centre of Novel Surgical Technologies, Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia.
Angiol Sosud Khir. 2016;22(1):142-58.
Analysed in the article are the results of the Ross procedure in patients presenting with dilatation of the ascending portion of the aorta. A combination of aortic valve defects with dilatation of the ascending aorta of more than 45 mm supposes simultaneous prosthetic repair of the aortic valve and ascending aorta. The most common surgical procedure remains the Bentall-DeBono operation whose main disadvantage is associated with implantation of a mechanical prosthesis and the necessity of lifelong anticoagulant therapy. An alternative method is the Ross procedure demonstrating low risk of thromboembolic complications and freedom from anticoagulant therapy. Over the period from 2002 to April 2015, specialists of the Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin carried out a total of 162 Ross procedures in patients presenting with accompanying dilatation of the ascending aorta (more than 45 mm). The mean diameter of the aorta at the level of Valsalva sinuses amounted to 45.6±8.6 mm, with that of the ascending aortic portion equalling 53.4±7.8 mm. The technique of total replacement of the aortic root was used in all cases. When the aneurysm extended to distal portions of the ascending aorta, additionally performed were the following procedures: in 24 patients--reduction aortoplasty, in 6 patients--replacement of the resected aorta with an insert from xenopericardium, and in 2 patients with a vascular graft. The average duration of follow up amounted to 40.1±21.6 months. Ten patients were subjected to repeat operations for autograft dysfunction. There were no reoperations on the ascending portion of the aorta. The regression analysis revealed that predictors of the development of autograft dysfunction were the baseline dilatation of the fibrous ring (FR) of the aortic valve of more than 27 mm (p=0.04) and uncorrected arterial hypertension in the postoperative period (p=0.03). In the group of patients with the FR less than 27 mm there were no cases of allograft dysfunction. The results of the study suggest that the Ross procedure is a safe and effective method in patients with accompanying dilatation of the ascending aorta. Risk factors for autograft dysfunction are dilatation of the FR of the aortic valve exceeding 27 mm and arterial hypertension in the postoperative period.
本文分析了患有升主动脉扩张患者的罗斯手术结果。主动脉瓣缺陷合并升主动脉扩张超过45毫米时，需同时进行主动脉瓣和升主动脉的人工修复。最常见的外科手术仍是本特-德博诺手术，其主要缺点与机械瓣膜植入及终身抗凝治疗的必要性有关。另一种方法是罗斯手术，其血栓栓塞并发症风险低且无需抗凝治疗。在2002年至2015年4月期间，以叶夫根尼·尼古拉耶维奇·梅沙尔金院士命名的新西伯利亚循环病理学科学研究所的专家，对162例伴有升主动脉扩张（超过45毫米）的患者进行了罗斯手术。主动脉瓣窦水平的主动脉平均直径为45.6±8.6毫米，升主动脉部分的直径为53.4±7.8毫米。所有病例均采用主动脉根部全置换技术。当动脉瘤延伸至升主动脉远端时，还进行了以下手术：24例患者进行了主动脉缩窄成形术，6例患者用异种心包补片置换切除的主动脉，2例患者使用了血管移植物。平均随访时间为40.1±21.6个月。10例患者因自体移植物功能障碍接受了再次手术。升主动脉未进行再次手术。回归分析显示，自体移植物功能障碍发生的预测因素是主动脉瓣纤维环（FR）基线扩张超过27毫米（p=0.04）和术后未纠正的动脉高血压（p=0.03）。在FR小于27毫米的患者组中，没有发生同种异体移植物功能障碍的病例。研究结果表明，罗斯手术对于伴有升主动脉扩张的患者是一种安全有效的方法。自体移植物功能障碍的危险因素是主动脉瓣FR扩张超过27毫米和术后动脉高血压。
