Jahanyar Jama, Arabkhani Bardia, Zanella Luca, de Kerchove Laurent, Tsai Peter I, Aphram Gaby, Mastrobuoni Stefano, El Khoury Gebrine
Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium.
Division of Cardiovascular and Thoracic Surgery, Queen's Heart Institute, Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
Ann Cardiothorac Surg. 2023 Jul 31;12(4):350-357. doi: 10.21037/acs-2023-avs2-0100. Epub 2023 Jul 20.
The Ross procedure has demonstrated excellent long-term results, with restoration of life-expectancy in patients with severe aortic valve dysfunction. However, reintervention after Ross can occur, and herein we describe our center's experience with redo surgery after previous Ross procedures.
We searched our prospective database for aortic valve-repair and recruited all adult (≥18 years) patients who have undergone valve-sparing root replacements (VSRRs) and/or aortic valve-repair after Ross procedure between July 2001 and July 2022. Univariable logistic regression analysis was performed to identify variables affecting early mortality. Survival, freedom-from-valve-reintervention and freedom-from-aortic regurgitation (AR) grade ≥3 were analyzed with the Kaplan-Meier method.
A total of 63 patients were recruited for this study. Indication for reoperation after Ross was aortic aneurysm without AR in 17 (27%), aortic aneurysm with AR in 27 (43%), and isolated AR in 19 (30%) patients. Median follow-up time was 7.82 years. The majority of patients (76%) had undergone the free root technique during their index Ross operation. Cumulative survival, after redo surgery following Ross, was 98.4% [95% confidence interval (CI): 89.3-99.8%] at 1 year, 96.3% (95% CI: 88.2-98.3%) at 5 years, and 92.4% (95% CI: 87.1-98.0%) at 10 years. Freedom-from-reoperation on the aortic valve at 1 year was 98.4% (95% CI: 97.0-99.8%), at 5 years was 96.7% (95% CI: 87.6-99.0%), and 79.7% (95% CI: 71.1-88.3%) at 10 years.
Long-term survival after redo surgery following the Ross operation is excellent. The data support our aggressive valve-sparing approach after Ross.
罗斯手术已显示出优异的长期效果，可恢复严重主动脉瓣功能不全患者的预期寿命。然而，罗斯手术后可能需要再次干预，在此我们描述我们中心在先前罗斯手术后再次手术的经验。
我们在我们的前瞻性数据库中搜索主动脉瓣修复病例，并纳入了2001年7月至2022年7月期间接受过罗斯手术后保留瓣膜的根部置换术（VSRR）和/或主动脉瓣修复的所有成年（≥18岁）患者。进行单变量逻辑回归分析以确定影响早期死亡率的变量。采用Kaplan-Meier方法分析生存率、免于瓣膜再次干预率和免于主动脉反流（AR）≥3级的情况。
本研究共纳入63例患者。罗斯手术后再次手术的指征为无AR的主动脉瘤17例（27%）、有AR的主动脉瘤27例（43%）和孤立性AR 19例（30%）。中位随访时间为7.82年。大多数患者（76%）在初次罗斯手术期间采用了游离根部技术。罗斯手术后再次手术后的累积生存率在1年时为98.4%[95%置信区间（CI）：89.3 - 99.8%]，5年时为96.3%（95% CI：88.2 - 98.3%），10年时为92.4%（95% CI：87.1 - 98.0%）。主动脉瓣免于再次手术率在1年时为98.4%（95% CI：97.0 - 99.8%），5年时为96.7%（95% CI：87.6 - 99.0%），10年时为79.7%（95% CI：71.1 - 88.3%）。
罗斯手术后再次手术的长期生存率极佳。这些数据支持我们在罗斯手术后积极的保留瓣膜方法。
