Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York.
Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2022;25:28-37. doi: 10.1053/j.pcsu.2022.04.002.
The ideal aortic valve substitute in young adults remains unknown. Prosthetic valves are associated with a suboptimal survival and carry a significant risk of valve-related complications in young patients, mainly reinterventions with tissue valves and, thromboembolic events and major bleeding with mechanical prostheses. The Ross procedure is the only substitute that restores a survival curve similar to that of a matched general population, and permits a normal life without functional limitations. Though the risk of reintervention is the Achilles' heel of this procedure, it is very low in patients with aortic stenosis and can be mitigated in patients with aortic regurgitation by tailored surgical techniques. Finally, the Ozaki procedure and the transcatheter aortic valve implantation are seen by many as future alternatives but lack evidence and long-term follow-up in this specific patient population.
在年轻成年人中，理想的主动脉瓣替代物仍不清楚。人工瓣膜与生存预后不理想相关，并且在年轻患者中存在瓣膜相关并发症的重大风险，主要是组织瓣膜的再次干预，以及机械瓣膜的血栓栓塞事件和大出血。Ross 手术是唯一一种可恢复与匹配一般人群相似生存曲线的替代物，并且可以使患者在没有功能限制的情况下正常生活。尽管再次干预的风险是该手术的致命弱点，但对于主动脉瓣狭窄的患者，这种风险非常低，并且可以通过定制的手术技术减轻主动脉瓣反流患者的风险。最后，Ozaki 手术和经导管主动脉瓣植入术被许多人视为未来的替代方案，但在这一特定患者群体中缺乏证据和长期随访。
