El Sherif Nibras, Dearani Joseph A, Connolly Heidi M, Bagameri Gabor, Pochettino Alberto, Stulak John M, Stephens Elizabeth H
Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2023 Mar;115(3):633-639. doi: 10.1016/j.athoracsur.2022.05.017. Epub 2022 May 26.
The Ross procedure has several advantages, but the need for reintervention is inevitable. The aim of this study was to examine the complexity and outcomes of reoperation after the Ross procedure.
Retrospective chart review was performed of patients with a prior Ross procedure who underwent reoperation at our institution from September 1991 to January 2021. Demographic, echocardiographic, surgical, and perioperative data were collected. Descriptive statistical and regression analyses were performed.
A total of 105 patients underwent a reoperation at Mayo Clinic after the initial Ross procedure performed at our institution (n = 16; 16.2%) or elsewhere (n = 83; 83.8%). Mean age at the Ross procedure was 27 ± 17 years, and mean age at reoperation at our institution was 37 ± 19 years. Indications for surgical procedure varied, but 64% had autograft regurgitation as 1 of their indications for reoperation. Autograft interventions were performed in 78 patients (74.2%). Pulmonary valve or conduit replacement was performed in 56 patients (53.3%). Double root replacement was performed in 11 patients (10.5%). Aortic reconstruction was performed in 37 patients (38.4%). There were 5 early deaths (5%). During a median follow-up of 6.25 years (3 months-24 years), late deaths occurred in 14 patients (13.1%). Patients with ejection fraction <30% on preoperative echocardiography had shorter duration between the Ross procedure and subsequent reoperation (P = .03).
Reoperations after the Ross procedure are performed for a wide range of indications, with most due to autograft dysfunction. The number of early deaths is not low. Reoperation after the Ross procedure should be advised before left ventricular systolic dysfunction.
罗斯手术有诸多优点，但再次干预不可避免。本研究旨在探讨罗斯手术后再次手术的复杂性及结果。
对1991年9月至2021年1月在我院接受过罗斯手术且再次手术的患者进行回顾性病历审查。收集人口统计学、超声心动图、手术及围手术期数据。进行描述性统计分析和回归分析。
共有105例患者在我院（n = 16；16.2%）或其他地方（n = 83；83.8%）首次进行罗斯手术后在梅奥诊所接受了再次手术。罗斯手术时的平均年龄为27±17岁，在我院再次手术时的平均年龄为37±19岁。手术指征各不相同，但64%的患者将自体移植物反流作为再次手术的指征之一。78例患者（74.2%）进行了自体移植物干预。56例患者（53.3%）进行了肺动脉瓣或管道置换。11例患者（10.5%）进行了双根部置换。37例患者（38.4%）进行了主动脉重建。有5例早期死亡（5%）。在中位随访6.25年（3个月至24年）期间，14例患者（13.1%）发生晚期死亡。术前超声心动图显示射血分数<30%的患者在罗斯手术与随后再次手术之间的间隔时间较短（P = 0.03）。
罗斯手术后再次手术的指征范围广泛，大多数是由于自体移植物功能障碍。早期死亡人数并不低。在左心室收缩功能障碍之前应建议进行罗斯手术后的再次手术。
