Pardo González Laura, Ruiz Ortiz Martin, Delgado Mónica, Mesa Dolores, Villalba Rafael, Rodriguez Sara, Hidalgo Francisco J, Alados Pedro, Casares Jaime, Suarez de Lezo Jose
Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain.
Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain.
Arch Cardiovasc Dis. 2017 Apr;110(4):214-222. doi: 10.1016/j.acvd.2016.09.008. Epub 2016 Dec 30.
The Ross procedure is used in the treatment of selected patients with aortic valve disease. Pulmonary graft stenosis can appear in the long-term follow-up after the Ross intervention, but the factors involved and its clinical implications are not fully known.
To describe the incidence, clinical impact and predictors of homograft stenosis and reintervention after the Ross procedure in a prospective series in a tertiary referral hospital.
From 1997 to 2009, 107 patients underwent the Ross procedure (mean age: 30±11 years; 69% men; 21 aged<18 years), and were followed for echocardiographic homograft stenosis (peak gradient>36mmHg) and surgical or percutaneous homograft reintervention.
After 15 years of follow-up (median: 11 years), echocardiographic and clinical data were available in 91 (85%) and 104 (98%) patients, respectively: 26/91 (29%) patients developed homograft stenosis; 10/104 (10%) patients underwent 13 homograft reintervention procedures (three patients underwent surgical replacement, three received a percutaneous pulmonary valve and one needed stent implantation). The other three patients underwent two consecutive procedures in follow-up; one died because of a procedure-related myocardial infarction. Rates of survival free from homograft stenosis and reintervention at 1, 5 and 10 years were 96%, 82% and 75% and 99%, 94% and 91%, respectively. Paediatric patients had worse survival free from homograft stenosis (hazard ratio [HR] 3.50, 95% confidence interval [CI]: 1.56-7.90; P=0.002), although there were no significant differences regarding reintervention (HR: 2.01, 95% CI: 0.52-7.78; P=0.31). Younger age of homograft donor was also a stenosis predictor (HR: 0.97, 95% CI: 0.94-0.99; P=0.046).
The probabilities of homograft stenosis and reintervention 10 years after the Ross procedure were 29% and 10%, respectively; only one patient had a reintervention-related death. Younger donor and recipient age were associated with a higher rate of stenosis.
Ross手术用于治疗特定的主动脉瓣疾病患者。肺动脉移植物狭窄可出现在Ross手术后的长期随访中，但相关因素及其临床意义尚不完全清楚。
描述一家三级转诊医院前瞻性队列中Ross手术后同种异体移植物狭窄及再次干预的发生率、临床影响和预测因素。
1997年至2009年，107例患者接受了Ross手术（平均年龄：30±11岁；69%为男性；21例年龄<18岁），并接受超声心动图检查以评估同种异体移植物狭窄（峰值梯度>36mmHg）以及手术或经皮同种异体移植物再次干预情况。
经过15年的随访（中位数：11年），分别有91例（85%）和104例（98%）患者获得了超声心动图和临床数据：26/91（29%）例患者出现同种异体移植物狭窄；10/104（10%）例患者接受了13次同种异体移植物再次干预手术（3例患者接受了手术置换，3例接受了经皮肺动脉瓣植入，1例需要支架植入）。另外3例患者在随访中接受了连续两次手术；1例因手术相关心肌梗死死亡。1年、5年和10年无同种异体移植物狭窄和再次干预的生存率分别为96%、82%和75%以及99%、94%和91%。儿科患者无同种异体移植物狭窄的生存率较差（风险比[HR] 3.50，95%置信区间[CI]：1.56 - 7.90；P = 0.002），尽管在再次干预方面无显著差异（HR：2.01，95% CI：0.52 - 7.78；P = 0.31）。同种异体移植物供体年龄较小也是狭窄的一个预测因素（HR：0.97，95% CI：0.94 - 0.99；P = 0.046）。
Ross手术后10年同种异体移植物狭窄和再次干预的概率分别为29%和10%；仅有1例患者死于再次干预相关原因。供体和受体年龄较小与较高的狭窄发生率相关。
