Starnes Vaughn A, Elsayed Ramsey S, Cohen Robbin G, Olds Anna P, Bojko Markian M, Mack Wendy J, Cutri Raffaello M, Baertsch Hans C, Baker Craig J, Kumar S Ram, Bowdish Michael E
Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif.
Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif.
J Thorac Cardiovasc Surg. 2023 Jan;165(1):43-52.e2. doi: 10.1016/j.jtcvs.2021.01.101. Epub 2021 Feb 4.
To compare outcomes with wrapped (pulmonary autograft inclusion) versus unwrapped techniques in adults with bicuspid aortic valves undergoing the Ross procedure.
Between 1992 and 2019, 129 adults with bicuspid aortic valves (aged ≥18 years) underwent the Ross procedure by a single surgeon. Patients were divided into those without autograft inclusion (unwrapped, n = 71) and those with autograft inclusion (wrapped, n = 58). Median follow-up was 10.3 years (interquartile range, 3.0-16.8 years). Need for autograft reintervention was analyzed using competing risks.
Pre- and intraoperative characteristics as well as 30-day morbidity or mortality did not differ between cohorts. Survival at 1, 5, and 10 years, respectively, was 97.2%, 97.2%, and 95.6% in the unwrapped cohort and 100%, 100%, and 100% in the wrapped cohort (P = .15). Autograft valve failure occurred in 25 (35.2%) of the unwrapped and 3 (5.2%) of the wrapped patients. Competing risks analysis demonstrated the wrapped cohort to have a lower need for autograft reintervention (subhazard ratio, 0.28, 95% confidence interval, 0.08-0.91; P = .035). The cumulative incidence of autograft reintervention (death as a competing outcome) at 1, 5, and 10 years, respectively, was 10.2%, 14.9%, and 26.8% in the unwrapped cohort and 4.0%, 4.0%, and 4.0% in the wrapped cohort.
In adults with bicuspid aortic valves, the Ross procedure with pulmonary autograft inclusion stabilizes the aortic root preventing dilatation and reduces the need for reoperation. The autograft inclusion technique allows the Ross procedure to be performed in this population with excellent long-term outcomes.
比较在接受罗斯手术的二叶式主动脉瓣成年患者中，采用包裹技术（包含自体肺动脉瓣）与未包裹技术的手术效果。
1992年至2019年间，129例二叶式主动脉瓣成年患者（年龄≥18岁）由同一位外科医生实施罗斯手术。患者被分为未包含自体肺动脉瓣组（未包裹组，n = 71）和包含自体肺动脉瓣组（包裹组，n = 58）。中位随访时间为10.3年（四分位间距，3.0 - 16.8年）。采用竞争风险分析自体肺动脉瓣再次干预的需求。
两组患者术前和术中特征以及30天发病率或死亡率无差异。未包裹组1年、5年和10年生存率分别为97.2%、97.2%和95.6%，包裹组分别为100%、100%和100%（P = 0.15）。未包裹组25例（35.2%）患者发生自体肺动脉瓣功能衰竭，包裹组3例（5.2%）发生。竞争风险分析显示，包裹组自体肺动脉瓣再次干预的需求较低（亚风险比，0.28，95%置信区间，0.08 - 0.91；P = 0.035）。未包裹组1年、5年和10年自体肺动脉瓣再次干预（以死亡作为竞争结局）的累积发生率分别为10.2%、14.9%和26.8%，包裹组分别为4.0%、4.0%和4.0%。
在二叶式主动脉瓣成年患者中，采用包含自体肺动脉瓣的罗斯手术可稳定主动脉根部，防止扩张，并减少再次手术的需求。包含自体肺动脉瓣技术使罗斯手术能在该人群中取得优异的长期效果。
