Pacifico A D, Kirklin J K, McGiffin D C, Matter G J, Nanda N C, Diethelm A G
Department of Surgery, University of Alabama at Birmingham 35294-0016.
J Heart Valve Dis. 1994 Jul;3(4):365-70.
Fifty-four consecutive patients underwent aortic valve replacement with a pulmonary autograft (Ross operation) over an 18-month period. It was inserted as an intra-aortic cylinder in 13 patients and as a total aortic root replacement in 41; unwrapped in 16, partially wrapped with autologous pericardium in 12 and completely wrapped with bovine pericardium in 13. There were two cardiac deaths, one death from mediastinitis, and two early reoperations to replace an incompetent autograft. Comparison of postoperative echocardiographic data showed a higher incidence of moderate and severe autograft incompetence in the intra-aortic cylinder group and also in the subset without previous operation which had a total root replacement without a complete wrap. Autograft function was best in the group which received a total root replacement with a complete wrap and in those with previous cardiac surgery who received an unwrapped autograft. This preliminary information with short follow up supports the use of complete wrapping of the autograft when it is used as a total root replacement particularly in older patients without previous cardiac surgery in whom future autograft growth is not desirable.
在18个月的时间里，54例连续患者接受了肺动脉自体移植主动脉瓣置换术（Ross手术）。13例患者将其作为主动脉内柱状物植入，41例患者进行全主动脉根部置换；16例未包裹，12例用自体心包部分包裹，13例用牛心包完全包裹。有2例心脏死亡，1例死于纵隔炎，2例早期再次手术以更换功能不全的自体移植物。术后超声心动图数据比较显示，主动脉内柱状物组以及未进行过手术、接受全根部置换且未完全包裹的亚组中，中度和重度自体移植物功能不全的发生率较高。自体移植物功能在接受全根部置换并完全包裹的组以及既往有心脏手术史且接受未包裹自体移植物的患者中最佳。这一短期随访的初步信息支持在将自体移植物用作全根部置换时进行完全包裹，特别是在既往无心脏手术史且不希望自体移植物未来生长的老年患者中。
