Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada.
Department of Cardiac Anesthesiology, Montreal Heart Institute, Montreal, Canada.
Expert Rev Med Devices. 2019 Nov;16(11):981-988. doi: 10.1080/17434440.2019.1685380. Epub 2019 Oct 31.
: Although the Ross procedure offers several advantages over standard prosthetic AVR, its use remains limited. The risk of pulmonary autograft dilatation requiring reintervention remains one of the main concerns. Consequently, multiple techniques have been developed in attempt to mitigate this complication.: This article reviews the incidence of pulmonary autograft dilatation, its risk factors and pathophysiology. The techniques of external pulmonary autograft support are discussed along with their respective advantages and limitations. Finally, future areas of research and developments are examined.: The risk of autograft dilatation is mainly prevalent in patients with aortic regurgitation and a dilated aortic annulus. In these selected patients, an external support may prevent dilatation of the autograft. However, any permanent support potentially restricts autograft root motion, mitigating some of the advantages associated with the Ross procedure. A bioresorbable matrix that could support the root during its initial adaptative phase could alleviate this problem. In our opinion, aggressive blood pressure control during the first postoperative year along with annular and sino-tubular junction support in selected patients provides optimal stability of autograft root dimensions while preserving root dynamics. Serial imaging and clinical follow-up are necessary to define the role of these various strategies.
尽管 Ross 手术相对于标准人工主动脉瓣置换术具有多项优势，但它的应用仍然受到限制。肺动脉瓣扩张需要再次干预的风险仍然是主要关注点之一。因此，已经开发出多种技术来试图减轻这种并发症。本文回顾了肺动脉瓣扩张的发生率、其危险因素和病理生理学。讨论了肺动脉瓣外部支持技术及其各自的优缺点。最后，还探讨了未来的研究和发展领域。自体移植物扩张的风险主要在主动脉瓣反流和主动脉瓣环扩张的患者中存在。在这些选定的患者中，外部支持可能会防止自体移植物扩张。然而，任何永久性的支撑都会限制自体移植物根部的运动，从而减轻与 Ross 手术相关的一些优势。一种可以在初始适应阶段支撑根部的生物可吸收基质可以缓解这个问题。我们认为，在术后第一年积极控制血压，以及在选定的患者中对瓣环和窦管交界进行支撑，可在保留根部动力的同时优化自体移植物根部尺寸的稳定性。需要进行连续的影像学和临床随访，以确定这些各种策略的作用。
