Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
J Thorac Cardiovasc Surg. 2018 Jul;156(1):79-86.e2. doi: 10.1016/j.jtcvs.2018.03.015. Epub 2018 Mar 12.
To define the function of the "Ross valves" and its clinical meaning in a practical valve performance classification as part of the outcome analysis.
From 1994 to 2017, 630 consecutive patients underwent the subcoronary Ross procedure at our institution. The valve performance classification combines hemodynamics, symptoms, and management criteria. Median follow-up was 12.5 years (maximum 22.3 years, 7404 patient-years, 99.4% completeness).
The mean age of the patients was 44.7 ± 11.9 years. Hospital deaths was 0.3% (n = 2). Twenty years after the operation survival was 73.1% (95% confidence interval [CI], 65.4%-81.6%) and statistically not different from the age- and gender-matched general population; freedom from reoperation was 85.9% (95% CI, 80.2%-92.0%; 0.6% per patient-year), 89.8% (95% CI, 84.3%-95.7%) for autograft, and 91.0% (95% CI, 86.3%-96.0%) for homograft. Preoperative annulus diameter, aortic regurgitation, annulus reinforcement, sinotubular junction reinforcement, and bicuspid aortic valve type were no significant risk factors for reoperation. At 20 years the probability of a patient being in valve performance class I to IV was 5%, 74%, 19%, and 1%, respectively. Time to reoperation was not different in bicuspid and tricuspid aortic valves; preoperative aortic stenosis tended to have better outcome of autograft function.
These up to 22 years data show that the subcoronary Ross procedure continues to provide an excellent tissue aortic valve replacement. The suggested valve performance classification emerged as a practical concept for outcome analysis with the probability of 79% being in the favorable class I or II at 20 years.
在实用的瓣膜性能分类中定义“罗斯瓣”的功能及其临床意义，作为结果分析的一部分。
1994 年至 2017 年，我院对 630 例连续患者行冠状动脉下罗斯手术。瓣膜性能分类结合了血流动力学、症状和管理标准。中位随访时间为 12.5 年（最长随访时间为 22.3 年，随访患者 7404 人年，随访完整率为 99.4%）。
患者的平均年龄为 44.7±11.9 岁。院内死亡率为 0.3%（n=2）。术后 20 年，生存率为 73.1%（95%可信区间，65.4%-81.6%），与年龄和性别匹配的一般人群无统计学差异；免于再次手术率为 85.9%（95%可信区间，80.2%-92.0%；0.6%/患者年），自体移植物为 89.8%（95%可信区间，84.3%-95.7%），同种异体移植物为 91.0%（95%可信区间，86.3%-96.0%）。术前瓣环直径、主动脉瓣反流、瓣环强化、窦管交界强化和二叶式主动脉瓣类型不是再次手术的显著危险因素。20 年后，患者处于瓣膜性能分级 I-IV 级的概率分别为 5%、74%、19%和 1%。二叶式和三叶式主动脉瓣的再次手术时间无差异；术前主动脉瓣狭窄自体移植物功能的预后较好。
这些长达 22 年的数据表明，冠状动脉下罗斯手术继续提供了一种出色的组织主动脉瓣置换。建议的瓣膜性能分类作为一种实用的概念出现，20 年后有 79%的患者处于有利的 I 级或 II 级。
