Shetty Varun, Narayan Pradeep, Rao Shekar, Tambrallimath Praveen, Makwana Rohan Kiritkumar, Gunaseelan Vikneswaran, Shetty Devi Prasad
Department of Cardiac Surgery, Narayana Health.
Department of Cardiac Surgery, Narayana Health.
Ann Thorac Surg. 2025 Sep 12. doi: 10.1016/j.athoracsur.2025.08.045.
Ross procedure is a valuable option for aortic valve replacement in young patients, but concerns about autograft durability and limited homograft availability, especially in resource-limited settings, have limited its use. This study evaluated long-term outcomes of the Ross procedure, focusing on the effectiveness of hand-made Dacron valved conduits as an alternative to homografts.
We retrospectively reviewed 252 patients (mean age 19.6 ± 12.5 years) who underwent the Ross procedure between 2001 and 2023 at a single center. Pulmonary artery reconstruction was performed using pulmonary homografts (n=176) or hand-made Dacron valve conduits (n=75). Long-term outcomes including mortality, reintervention, and valve function were analyzed using Kaplan-Meier estimates and multivariate regression models.
Early mortality was 1.6%. Median follow up was 6.4 years (IQR 0.8-15 years). At 10 years, freedom from all-cause mortality was 94.3% (95% CI: 91.0-97.7), and freedom from Ross-related reintervention was 89% (95% CI: 84-94). Ross-related reinterventions were performed in 16(6%) cases, 13 surgical(8 autograft, 5 pulmonary conduit) and 3 balloon valvuloplasties for conduit stenosis. Dacron valved conduits had similar mean right ventricular outflow tract gradients (17.5 ± 9.9 vs. 16.5 ± 12.7 mmHg, p=0.75) and comparable overall reintervention rates (2.6% vs. 3.4%, p=0.93). Younger age was the only independent predictor of late aortic regurgitation (adjusted OR 0.90; 95% CI: 0.82-0.98, p = 0.01).
The Ross procedure demonstrates excellent long-term survival and valve durability in young patients. Dacron valve conduits offer a safe and effective alternative to homografts for pulmonary valve replacement.
Ross手术是年轻患者主动脉瓣置换的一种有价值的选择，但对自体移植物耐久性的担忧以及同种异体移植物供应有限，尤其是在资源有限的环境中，限制了其应用。本研究评估了Ross手术的长期结果，重点关注手工制作的涤纶带瓣管道作为同种异体移植物替代品的有效性。
我们回顾性分析了2001年至2023年在单一中心接受Ross手术的252例患者（平均年龄19.6±12.5岁）。使用肺动脉同种异体移植物（n = 176）或手工制作的涤纶带瓣管道（n = 75）进行肺动脉重建。使用Kaplan-Meier估计和多变量回归模型分析包括死亡率、再次干预和瓣膜功能在内的长期结果。
早期死亡率为1.6%。中位随访时间为6.4年（四分位间距0.8 - 15年）。10年时，全因死亡率的无事件生存率为94.3%（95%置信区间：91.0 - 97.7），与Ross相关的再次干预的无事件生存率为89%（95%置信区间：84 - 94）。16例（6%）患者进行了与Ross相关的再次干预，13例为手术干预（8例自体移植物，5例肺动脉管道），3例因管道狭窄进行了球囊瓣膜成形术。涤纶带瓣管道的平均右心室流出道梯度相似（17.5±9.9 vs. 16.5±12.7 mmHg，p = 0.75），总体再次干预率相当（2.6% vs. 3.4%，p = 0.93）。年轻是晚期主动脉瓣反流的唯一独立预测因素（校正比值比0.90；95%置信区间：0.82 - 0.98，p = 0.01）。
Ross手术在年轻患者中显示出优异的长期生存率和瓣膜耐久性。涤纶带瓣管道为肺动脉瓣置换提供了一种安全有效的同种异体移植物替代方案。
