Shih Emily, Brinkman William T, Harrington Katherine B, Squiers John J, Rahimighazikalayeh Gelareh, DiMaio J Michael, Ryan William H
Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Tex; Baylor Scott and White Research Institute, Dallas, Tex.
Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Tex.
J Thorac Cardiovasc Surg. 2023 May;165(5):1803-1812.e2. doi: 10.1016/j.jtcvs.2022.04.023. Epub 2022 May 14.
The Ross procedure is not commonly performed, owing to the procedural complexity and the risk of autograft and/or homograft reoperation. This study examined outcomes of patients undergoing Ross reinterventions at a dedicated Ross center.
We retrospectively reviewed 225 consecutive patients who underwent a Ross procedure between 1994 and 2019. Index and redo operation characteristics and outcomes were compared between patients with and those without redo operations. Multivariate analysis was used to identify independent predictors of Ross-related reinterventions. Survival was estimated with Kaplan-Meier analysis.
Sixty-six patients (29.3%) required redo Ross surgery, 41 patients (18.2%) underwent autograft reoperation only, 8 patients (3.6%) had a homograft reintervention, and 17 patients (7.6%) had both autograft and homograft reoperations (12 as a combined procedure and 5 as sequential procedures). The mean time to reintervention was 11 ± 6 years for autograft reoperations and 12 ± 7 years for homograft reoperations. Patients who underwent Ross-related reinterventions were younger (mean, 38 ± 11 years vs 43 ± 11 years; P < .01) and had a higher rate of New York Heart Association class III/IV (56% vs 38%; P = .02) at the index Ross procedure. Most patients undergoing autograft reintervention had aortic insufficiency and/or aneurysm (98.2%; 57 of 58). The primary reason for homograft reintervention was pulmonary stenosis (92%; 23 of 25). The operative mortality of Ross reintervention was 1.5% (1 of 66). Survival at 15 years was similar in patients who required a redo operation and those who did not (91.2% vs 93.9%; P = .23).
Ross reinterventions can be performed safely and maintain patients at the normal life expectancy restored by the index Ross procedure up to 15 years at experienced centers.
由于手术复杂性以及自体移植物和/或同种异体移植物再次手术的风险，Ross手术并不常用。本研究调查了在一家专门的Ross中心接受Ross再次手术患者的结局。
我们回顾性分析了1994年至2019年间连续接受Ross手术的225例患者。比较了接受再次手术和未接受再次手术患者的初次手术及再次手术的特征和结局。采用多因素分析确定Ross相关再次手术的独立预测因素。采用Kaplan-Meier分析评估生存率。
66例患者（29.3%）需要再次进行Ross手术，41例患者（18.2%）仅接受了自体移植物再次手术，8例患者（3.6%）进行了同种异体移植物再次干预，17例患者（7.6%）同时进行了自体移植物和同种异体移植物再次手术（12例为联合手术，5例为序贯手术）。自体移植物再次手术的平均再次手术时间为11±6年，同种异体移植物再次手术为12±7年。接受Ross相关再次手术的患者更年轻（平均年龄38±11岁对43±11岁；P<0.01），且在初次Ross手术时纽约心脏协会III/IV级的比例更高（56%对38%；P=0.02）。大多数接受自体移植物再次手术的患者存在主动脉瓣关闭不全和/或动脉瘤（98.2%；58例中的57例）。同种异体移植物再次干预的主要原因是肺动脉狭窄（92%；25例中的23例）。Ross再次手术的手术死亡率为1.5%（66例中的1例）。需要再次手术和不需要再次手术的患者15年生存率相似（91.2%对93.9%；P=0.23）。
在经验丰富的中心，Ross再次手术可以安全进行，并能使患者在初次Ross手术后恢复的正常预期寿命内维持长达15年。
