Shih Emily, Squiers John J, Brinkman William T, Harrington Katherine B, Schaffer Justin M, DiMaio J Michael, Ryan William H
Department of Cardiothoracic Surgery, The Heart Hospital Baylor Scott and White, Plano, Texas.
Baylor Scott and White Research Institute, Dallas, Texas.
Ann Thorac Surg Short Rep. 2022 Dec 26;1(2):307-310. doi: 10.1016/j.atssr.2022.12.009. eCollection 2023 Jun.
Recent reports that the Ross procedure restores normal life expectancy in young adults with aortic valve disease have renewed interest in this complex procedure. Because only a few centers perform a high volume of Ross procedures, there are limited data on the safety of learning and teaching the Ross procedure.
A total of 234 consecutive adult patients at a single center underwent the Ross procedure performed by an experienced surgeon acting as the primary operator (n = 186; 1994-2021) or mentoring surgeon (n = 48; 2001-2021). Cumulative sum analysis of cardiopulmonary bypass times was performed to evaluate learning curves as primary surgeon and mentored surgeon. Kaplan-Meier analysis was used to estimate long-term survival and freedom from Ross-related reintervention.
Patients' mean age was 42 ± 11 years; 169 (72%) were male. Baseline demographic characteristics were similar between cohorts. Operative death occurred in 5 (2%) patients: 3 (2%) as primary surgeon and 2 (4%) as mentor ( = .28). In-hospital reoperation was required in 8 (3%) patients: 6 (3%) as primary surgeon and 2 (4%) as mentor ( = .75). Up to 10 years, there was no difference in survival between primary operator cases and mentored cases (94.4% [91.2%-97.9%]) vs 95.8% [90.3%-100%]; log-rank, = .85).
Although the Ross procedure is technically complex, it can be taught to experienced aortic root surgeons without compromising short- or long-term outcomes.
最近有报道称，罗斯手术可恢复患有主动脉瓣疾病的年轻成年人的正常预期寿命，这重新引发了人们对这一复杂手术的兴趣。由于只有少数几个中心进行大量的罗斯手术，关于学习和教授罗斯手术安全性的数据有限。
在一个中心，共有234例连续的成年患者接受了罗斯手术，手术由一位经验丰富的外科医生作为主刀医生（n = 186；1994 - 2021年）或指导医生（n = 48；2001 - 2021年）进行。对体外循环时间进行累积和分析，以评估作为主刀医生和指导医生的学习曲线。采用Kaplan-Meier分析来估计长期生存率和免于与罗斯手术相关的再次干预的概率。
患者的平均年龄为42±11岁；169例（72%）为男性。两组患者的基线人口统计学特征相似。5例（2%）患者发生手术死亡：主刀医生组3例（2%），指导医生组2例（4%）（P = 0.28）。8例（3%）患者需要进行院内再次手术：主刀医生组6例（3%），指导医生组2例（4%）（P = 0.75）。长达10年，主刀医生组病例和指导医生组病例的生存率无差异（94.4%[91.2% - 97.9%]对95.8%[90.3% - 100%]；对数秩检验，P = 0.85）。
尽管罗斯手术技术复杂，但可以教授给有经验的主动脉根部外科医生，而不会影响短期或长期疗效。
