Sankhyan Lakshmi Kumari, Ghosh Rajarshi, Kumar Santosh, Chatterjee Sujoy, Bhattachariya Sudipta, Das Saurabhi, Nayak Hemant Kumar, Bose Satyajit, Chatterjee Srirup
Department of Cardiothoracic and Vascular Surgery, The Mission Hospital, Durgapur, West Bengal 713212 India.
Department of Pediatric Cardiology, The Mission Hospital, Durgapur, West Bengal 713212 India.
Indian J Thorac Cardiovasc Surg. 2020 Jan;36(1):28-36. doi: 10.1007/s12055-019-00845-8. Epub 2019 Jul 23.
The Ross procedure is an established option for aortic valve disease in children. Due to limited availability of pulmonary homograft, we devised a novel technique for right ventricular outflow tract (RVOT) reconstruction by preparing indigenous Dacron valved conduit.
Forty consecutive cases of modified Ross procedure done at our center (2013-2018) were analyzed. Thirty-seven patients (95%) were followed up with median duration of 2.5 (0.08-5.5) years. Median age was 12 (5-39) years. Nineteen (47.5%) patients had rheumatic aortic valve disease, while 19 (47.5%) had congenital aortic valve disease. Aortic root replacement with pulmonary autograft was performed in all patients. Dacron conduit for RVOT reconstruction was used with on table sewn bileaflet valve using Dacron patch ( = 22), expanded polytetrafluoroethylene (ePTFE) membrane ( = 10), bioprosthetic valve ( = 4), and pericardium ( = 4). Additional surgical procedures included mitral valve repair ( = 10), septal myectomy ( = 2), ascending aorta replacement ( = 1), ruptured sinus of valsalva (RSOV) repair ( = 1), and ventricular septal defect (VSD) closure ( = 1).
There was one in-hospital mortality while one late death occurred at 3.5 years postoperatively. The neo-aortic valve regurgitation on echocardiographic evaluation at last follow-up was trivial ( = 28), mild ( = 7), and moderate ( = 2). Mild RVOT obstruction was present in 8 patients while 18 patients had mild pulmonary regurgitation. No patient required reintervention during follow-up.
Our early results of modified Ross procedure are encouraging, however, long-term follow-up is required.
罗斯手术是治疗儿童主动脉瓣疾病的一种既定方法。由于肺动脉同种异体移植物的可用性有限，我们设计了一种通过制备国产涤纶带瓣管道来重建右心室流出道（RVOT）的新技术。
分析了在我们中心（2013 - 2018年）连续进行的40例改良罗斯手术病例。37例患者（95%）得到随访，中位随访时间为2.5（0.08 - 5.5）年。中位年龄为12（5 - 39）岁。19例（47.5%）患者患有风湿性主动脉瓣疾病，19例（47.5%）患有先天性主动脉瓣疾病。所有患者均进行了自体肺动脉移植替换主动脉根部。用于RVOT重建的涤纶管道与在手术台上用涤纶补片缝合的双叶瓣（= 22）、膨体聚四氟乙烯（ePTFE）膜（= 10）、生物人工瓣膜（= 4）和心包（= 4）一起使用。额外的外科手术包括二尖瓣修复（= 10）、室间隔心肌切除术（= 2）、升主动脉置换（= 1）、瓦氏窦破裂（RSOV）修复（= 1）和室间隔缺损（VSD）闭合（= 1）。
有1例住院死亡，1例术后3.5年发生晚期死亡。末次随访时超声心动图评估的新主动脉瓣反流情况为微量（= 28）、轻度（= 7）和中度（= 2）。8例患者存在轻度RVOT梗阻，18例患者有轻度肺动脉反流。随访期间无患者需要再次干预。
我们改良罗斯手术的早期结果令人鼓舞，然而，仍需要长期随访。
