Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
Congenital Heart Disease Research Group, Population Health Science Institute, Newcastle University, Newcastle Upon Tyne, UK.
Eur J Cardiothorac Surg. 2021 Nov 2;60(5):1112-1121. doi: 10.1093/ejcts/ezab193.
Our goal was to present 2 decades of our experience with the Ross procedure and its sequential modifications, adopted since 2010, to improve the reoperation rate.
We performed a single-centre, retrospective review of database information and medical notes about the implantation technique: the freestanding root. We compared era 1 (1997-2009) and era 2 (2010-2019).
Between 1997 and 2019, a total of 214 Ross procedures were performed (71% men, median age 24 years) [interquartile range (IQR) 15-38]. Of these, 87% had various forms of congenital-dysplastic aortic valves. The median cross-clamping and bypass times were 173 (IQR 148-202) and 202 (IQR 182-244) min. The median postoperative stay was 6 days (2-77). Thirty-day mortality was 0.5%. The median follow-up time was 8.2 years (IQR 3.9-13.2). Survival at 10 and 20 years was 97% and 95%; freedom from greater than moderate aortic regurgitation or aortic valve intervention was 91% and 80%; and 93% of the patients were in New York Heart Association functional class I. Twenty (21%) patients operated on during era 1 and 6 (9%) during era 2 underwent autograft reoperations. The median follow-up time was 14.3 (IQR 11.5-17.4) and 4.8 (IQR 2.5-7) years. Freedom from autograft reoperation was 87% and 69% at 10 and 20 years, with no significant difference between eras. Freedom from homograft reoperation was 96% and 76% at 10 and 20 years. The presence of aortic regurgitation, infective endocarditis and era 1 were predictors of autograft reoperation. Male gender and era 1 were predictors of neoaortic root dilatation.
The contemporary modified Ross procedure continues to deliver excellent results and should remain part of the strategy to treat children and young adults requiring aortic valve replacement.
介绍自 2010 年以来，我们采用的 Ross 手术及其序贯改良方法的 20 年经验，以降低再次手术率。
我们对数据库信息和医疗记录进行了单中心回顾性分析，介绍了游离体根的植入技术。我们比较了两个时期：1997-2009 年为时期 1，2010-2019 年为时期 2。
1997 年至 2019 年，共进行了 214 例 Ross 手术（71%为男性，中位年龄 24 岁[四分位间距（IQR）15-38]）。其中，87%的患者有各种形式的先天性发育不良主动脉瓣。中位体外循环和转流时间分别为 173（IQR 148-202）和 202（IQR 182-244）分钟。中位术后住院时间为 6 天（2-77）。30 天死亡率为 0.5%。中位随访时间为 8.2 年（IQR 3.9-13.2）。10 年和 20 年的生存率分别为 97%和 95%；大于中度主动脉瓣反流或主动脉瓣干预的无事件生存率分别为 91%和 80%；93%的患者纽约心脏协会心功能分级为Ⅰ级。1 期手术的 20 例（21%）和 2 期手术的 6 例（9%）患者接受了自体移植物再次手术。中位随访时间分别为 14.3（IQR 11.5-17.4）和 4.8（IQR 2.5-7）年。10 年和 20 年时，自体移植物无再次手术率分别为 87%和 69%，两个时期无显著差异。同种异体移植物无再次手术率分别为 96%和 76%。主动脉瓣反流、感染性心内膜炎和时期 1 是自体移植物再次手术的预测因素。男性和时期 1 是新主动脉根部扩张的预测因素。
现代改良 Ross 手术继续提供优异的结果，应继续作为治疗需要主动脉瓣置换的儿童和青少年的策略的一部分。
