Chauvette Vincent, Bouhout Ismail, Laurin Charles, Williams Elbert E, Cartier Raymond, Poirier Nancy, Demers Philippe, El-Hamamsy Ismail
Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Department of Cardiac Surgery, CHU-ME Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
J Thorac Cardiovasc Surg. 2025 Oct 14. doi: 10.1016/j.jtcvs.2025.09.054.
Contemporary evidence supports use of the Ross procedure (pulmonary autograft) to treat patients with aortic valve disease. No studies have evaluated the impact of autograft repair to correct residual aortic regurgitation (AR) at index Ross on late outcomes.
This study includes patients undergoing a Ross procedure followed by concomitant autograft valve repair at two institutions. Autograft repair was defined as correction of residual AR during the same admission for the Ross procedure.
Between 2011 and 2024, 675 patients underwent a Ross procedure in 2 large volume institutions. Of them, 22 (3%) underwent autograft repair for post-procedural AR (mean age: 52 yo, 23% female). Fourteen patients had a bicuspid valve (64%) and 5 had a unicuspid aortic valve (23%). One patient had a bicuspid autograft. Residual AR was eccentric in 8 patients (36%), commissural in 9 (41%) and combined in 5 (23%). AR was corrected using central plication sutures in 13 patients (59%) and commissuroplasty in 14 patients (63%). There were no perioperative deaths. One patient required reintervention and conversion to a Bentall procedure 6 days after the index Ross procedure. All but one (5%; mild AR) had none/trivial AR on discharge. At a median echocardiographic follow-up of 3 years (Q1-Q3: 2-8), seven patients have mild AR (32%), and one patient developed mild-to-moderate AR after 7 years. All other patients have no/trivial AR. At 5 years, the cumulative incidence of AR>2 is 6±6%.
Addressing post-procedural AR after autograft implantation is safe and associated with durable outcomes in the first decade. These findings support correction of post-procedural commissural and/or eccentric jets at the time of index operation.
当代证据支持采用罗斯手术（肺动脉自体移植）治疗主动脉瓣疾病患者。尚无研究评估初次罗斯手术时自体移植瓣膜修复对纠正残余主动脉瓣反流（AR）及其晚期结局的影响。
本研究纳入了在两家机构接受罗斯手术并同期进行自体移植瓣膜修复的患者。自体移植瓣膜修复定义为在罗斯手术的同一住院期间纠正残余AR。
2011年至2024年期间，两家大型机构的675例患者接受了罗斯手术。其中，22例（3%）因术后AR接受了自体移植瓣膜修复（平均年龄：52岁，23%为女性）。14例患者为二叶式瓣膜（64%），5例为单叶式主动脉瓣（23%）。1例患者为二叶式自体移植瓣膜。8例患者（36%）的残余AR为偏心性，9例（41%）为瓣叶连合处反流，5例（23%）为两者兼有。13例患者（59%）采用中央折叠缝合纠正AR，14例患者（63%）采用瓣叶连合处成形术。无围手术期死亡病例。1例患者在初次罗斯手术后6天需要再次干预并转换为Bentall手术。除1例（5%；轻度AR）外，所有患者出院时均无/微量AR。在中位超声心动图随访3年时（四分位间距：2 - 8年），7例患者有轻度AR（32%），1例患者在7年后出现轻度至中度AR。所有其他患者无/微量AR。5年时，AR>2+的累积发生率为6±6%。
自体移植瓣膜植入术后处理术后AR是安全的，且在首个十年内结局持久。这些发现支持在初次手术时纠正术后瓣叶连合处和/或偏心性反流。
