Bouhout Ismail, Noly Pierre-Emmanuel, Ghoneim Aly, Stevens Louis-Mathieu, Cartier Raymond, Poirier Nancy, Bouchard Denis, Demers Philippe, El-Hamamsy Ismail
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montreal, Université de Montréal, Montreal, Canada.
Interact Cardiovasc Thorac Surg. 2017 Jan;24(1):41-47. doi: 10.1093/icvts/ivw325. Epub 2016 Sep 23.
The aim of this study was to compare perioperative outcomes in young adults following isolated Ross procedure versus mechanical aortic valve replacement (AVR) in a high-volume centre.
From 2007 to 2015, 337 elective isolated mechanical AVRs and 137 Ross procedures were performed in young adults (<65 years) at our centre. Using a 1:1 propensity score match analysis, 140 patients were included in the study (n = 70 in each group). Perioperative outcomes were defined using STS guidelines. The primary outcome was operative mortality.
Median age was 52 [14] years and EuroSCORE II was 1.0 [0.4]%. There were no mortalities in the two groups. There were no differences in the incidence of myocardial injury (0% overall) and neurological complications (0.7% overall). Three (4%) reinterventions for bleeding were required in the Ross cohort versus six (9%) in the mechanical AVR cohort (P = 0.49). A significant increase in serum creatinine (>2-fold increase) was more commonly observed after the Ross procedure (11 vs 1%; P = 0.03), but there was no significant difference in the rate of temporary dialysis. Twenty-seven patients (39%) required ≥1 blood product transfusion in the Ross group, whereas 21 patients (31%) did so in the mechanical AVR group (P = 0.47). Median hospital length of stay was similar in both the groups (6 days).
There are no differences in mortality or major perioperative outcomes in adults undergoing an isolated Ross procedure or mechanical AVR.
本研究旨在比较在一个高容量中心，年轻成人接受单纯Ross手术与机械主动脉瓣置换术（AVR）后的围手术期结局。
2007年至2015年，我们中心对年龄小于65岁的年轻成人进行了337例择期单纯机械AVR手术和137例Ross手术。采用1:1倾向评分匹配分析，140例患者纳入研究（每组70例）。围手术期结局根据胸外科医师协会（STS）指南定义。主要结局为手术死亡率。
中位年龄为52[14]岁，欧洲心脏手术风险评估系统（EuroSCORE）II评分为1.0[0.4]%。两组均无死亡病例。心肌损伤发生率（总体为0%）和神经系统并发症发生率（总体为0.7%）无差异。Ross组有3例（4%）因出血需要再次干预，而机械AVR组有6例（9%）（P=0.49）。Ross手术后更常观察到血清肌酐显著升高（升高超过2倍）（11例对1例；P= .03），但临时透析率无显著差异。Ross组有27例患者（39%）需要≥1次输血，而机械AVR组有21例患者（31%）需要输血（P=0.47）。两组的中位住院时间相似（6天）。
接受单纯Ross手术或机械AVR的成人在死亡率或主要围手术期结局方面无差异。
