Bilodeau Kyle S, Mauchley David C, DeRoo Scott, Burke Christopher R
Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, WA USA.
Department of Surgery, Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, WA USA.
Cardiothorac Surg. 2023;31(1):28. doi: 10.1186/s43057-023-00119-5. Epub 2023 Dec 20.
The science of dissemination and implementation (D&I) aims to improve the quality and effectiveness of care by addressing the challenges of incorporating research and evidence-based practice into routine clinical practice. This lens of D&I has challenged the interpretation and incorporation of data, noting that failure of a given therapy may not reflect lack of efficacy, but instead reflect an imperfect implementation. The aim of this manuscript is to review the influence of the Ross procedure's historical context on its D&I.
A contextual baseline of the Ross procedure was defined from the procedure's original description in the literature to major publications since the 2017 valvular heart disease guidelines. D&I evaluation was conducted using the Consolidated Framework for Implementation Research (CFIR), using constructs from each of the five respective domains to define the main determinants.
Each of the five CFIR domains appears to be correlated with a factor influencing the Ross procedure's varied history of enthusiasm and acceptance. The complex nature of Ross required adaptation for optimization, with a strong correlation of center volume on outcomes that were not considered in non-contemporary studies. Outcomes later published from those studies influenced social and cultural contexts within the aortic surgery community, and led to further organizational uncertainty, resulting in slow guideline incorporation.
The D&I of the Ross procedure was a result of inadequate appreciation of technical complexity, effect of patient selection, and complex aortic surgery experience, resulting in dismissal of an efficacious procedure due to a misunderstanding of effectiveness.
传播与实施科学（D&I）旨在通过应对将研究和循证实践纳入常规临床实践所面临的挑战，来提高医疗质量和效果。D&I这一视角对数据的解读和纳入提出了挑战，指出特定治疗方法的失败可能并非反映其缺乏疗效，而是反映了实施过程存在缺陷。本文的目的是回顾罗斯手术的历史背景对其传播与实施的影响。
罗斯手术的背景基线是从该手术在文献中的最初描述到2017年瓣膜性心脏病指南发布后的主要出版物来确定的。使用实施研究综合框架（CFIR）进行传播与实施评估，利用五个各自领域中的构建要素来确定主要决定因素。
CFIR的五个领域中的每一个似乎都与影响罗斯手术热情和接受程度不同历史的一个因素相关。罗斯手术的复杂性要求进行调整以实现优化，中心手术量与非当代研究未考虑的结果之间存在强烈相关性。这些研究后来发表的结果影响了主动脉外科界的社会和文化背景，并导致了进一步的组织不确定性，从而导致指南纳入缓慢。
罗斯手术的传播与实施是由于对技术复杂性、患者选择的影响以及复杂主动脉手术经验认识不足所致，因对有效性的误解而导致一种有效的手术被摒弃。
