Joyce F, Tingleff J, Pettersson G
Department of Cardiothoracic Surgery, National University Hospital-Rigshospitalet, Copenhagen, Denmark.
J Heart Valve Dis. 1996 Jul;5(4):391-401; discussion 401-3.
The Ross operation is a technically demanding procedure. The pressure on the surgeon to produce consistently good results from the very first operation is great, since he is not afforded the luxury of a very soft "learning curve", as is the case with many technically difficult operations, due to the availability of acceptable and safe alternatives for most Ross candidates. We have felt this pressure from the outset and this has motivated a commitment to the development of a systematic surgical technique in an attempt to achieve consistently excellent results. Maintenance of normal autograft spatial geometry after translocation to the aortic position is necessary to ensure proper leaflet coaptation and to avoid autograft insufficiency, and this is the underlying principle upon which this technique is based. Most Ross operations are now performed as total aortic root replacements with a free-standing autograft, However, the autograft is soft and compliant, and will adapt to the dimensions of the more solid tissue into which it is inserted, the aortic annulus proximally and ascending aorta distally, and root replacement will not guarantee that normal autograft geometry will be maintained unless there is a correct size match between the autograft and the aortic annulus and sino-tubular junction, and the autograft is not distorted in other ways. A systematic technical approach to the Ross operation so that size mismatch is avoided and autograft geometry is maintained has been developed and is described in step-by-step detail. In the first third of this series of 85 patients, two patients had moderate (2+) and three patients had mild (1+) immediate postoperative autograft insufficiency. As our understanding of the important sizing and orientation issues has increased and the systematic technique has evolved, the incidence of early autograft insufficiency has essentially been eliminated. In the latter 2/3 of the series, all patients had less than mild autograft insufficiency, except one patient who had mild (1+) insufficiency. We believe that these results validate the principles on which this systematic technical approach is based and that the methods described will help both current and future Ross surgeons perform consistently successful operations.
罗斯手术是一项技术要求很高的手术。由于大多数罗斯手术候选人都有可接受且安全的替代方案，外科医生从第一例手术起就面临着持续取得良好效果的巨大压力，因为他不像许多技术难度大的手术那样有非常平缓的“学习曲线”。从一开始我们就感受到了这种压力，这促使我们致力于开发一种系统的手术技术，试图持续取得优异的效果。将自体移植物转移到主动脉位置后维持其正常的空间几何形状对于确保瓣叶正常对合和避免自体移植物功能不全是必要的，这就是该技术所基于的基本原则。现在大多数罗斯手术是作为独立自体移植物的全主动脉根部置换术进行的，然而，自体移植物柔软且顺应性好，会适应其植入的更坚实组织的尺寸，即近端的主动脉瓣环和远端的升主动脉，除非自体移植物与主动脉瓣环和窦管交界处尺寸匹配正确且自体移植物没有以其他方式变形，否则根部置换并不能保证维持自体移植物的正常几何形状。已经开发出一种罗斯手术的系统技术方法，以避免尺寸不匹配并维持自体移植物的几何形状，并将逐步详细描述。在这组85例患者的前三分之一中，有2例患者术后即刻出现中度（2+）自体移植物功能不全，3例患者出现轻度（1+）自体移植物功能不全。随着我们对重要的尺寸和定位问题的认识增加以及系统技术的发展，早期自体移植物功能不全的发生率已基本消除。在该组患者的后三分之二，除1例患者有轻度（1+）功能不全外，所有患者的自体移植物功能不全均小于轻度。我们相信这些结果验证了这种系统技术方法所基于的原则，并且所描述的方法将有助于当前和未来的罗斯手术外科医生持续成功地进行手术。
