El-Hamamsy Ismail, Bouhout Ismail
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montreal, Quebec, Canada.
Ann Transl Med. 2017 Mar;5(6):142. doi: 10.21037/atm.2017.01.64.
The ideal aortic valve substitute for young adults requiring aortic valve replacement (AVR) remains elusive. Young and middle-aged patients have a longer anticipated life expectancy and a higher level of physical activity than their elderly counterparts. In recent years, there has been a growing focus on long-term outcomes following AVR in this specific patient population. These studies highlight the direct impact of the choice of prosthesis on long-term survival, quality of life and rates of valve-related complications in younger adults. Although conventional AVR using a biological or mechanical prosthesis significantly improve the natural history of the disease, there are many inherent limitations, which need to be addressed. Despite declining use of the Ross procedure in recent years, several long-term registry, cohort and comparative studies in the last decade, indicate a clear role for this operation in young and middle-aged adults requiring AVR. These advantages are manifest in terms of long-term survival, freedom from valve-related complications and quality of life. In this Perspective article, we discuss findings from a recently published propensity-matched analysis of long-term outcomes following mechanical AVR versus the Ross procedure, showing better cardiac- and valve-related survival in the Ross cohort, lower rates of stroke and major bleeding and equal rates of reoperation at 20 years. These data are placed in the broader context of currently available evidence regarding the Ross procedure and a broader discussion pertaining to its role in today's practice and the need to reexamine current valvular guidelines so they are more reflective of the actual evidence.
对于需要进行主动脉瓣置换术（AVR）的年轻成年人来说，理想的主动脉瓣替代品仍然难以找到。与老年患者相比，中青年患者预期寿命更长，身体活动水平更高。近年来，针对这一特定患者群体进行主动脉瓣置换术后的长期结果越来越受到关注。这些研究强调了假体选择对年轻成年人长期生存、生活质量和瓣膜相关并发症发生率的直接影响。尽管使用生物或机械假体进行传统的主动脉瓣置换术能显著改善疾病的自然病程，但仍存在许多固有局限性，需要加以解决。尽管近年来罗斯手术（Ross procedure）的使用有所减少，但过去十年的几项长期注册研究、队列研究和比较研究表明，该手术在需要进行主动脉瓣置换术的中青年成年人中具有明确作用。这些优势在长期生存、无瓣膜相关并发症以及生活质量方面都很明显。在这篇观点文章中，我们讨论了最近发表的一项关于机械主动脉瓣置换术与罗斯手术长期结果的倾向匹配分析结果，该分析显示罗斯队列中心脏和瓣膜相关生存率更高，中风和大出血发生率更低，20年再次手术率相同。这些数据被置于关于罗斯手术的现有证据的更广泛背景下，并进行了更广泛的讨论，涉及该手术在当今实践中的作用以及重新审视当前瓣膜指南的必要性，以便它们更能反映实际证据。
