Reddy V M, McElhinney D B, Hanley F L
Division of Cardiothoracic Surgery, University of California, San Francisco, USA.
Isr J Med Sci. 1996 Oct;32(10):888-91.
Although it has been almost 30 years since Ross described his technique for aortic valve replacement using the pulmonary autograft, only recently has there been widespread interest in the use of the Ross procedure for aortic valve replacement in children with congenital heart disease. Since July 1992 we have performed the Ross procedure in 46 patients, 40 of whom were < or = 18 years of age at the time of surgery. In 10 children the procedure was combined with Konno ventriculoplasty, and in 3 others a Ross-Konno procedure was used for biventricular repair of borderline hypoplastic left heart syndrome. The only early deaths were in two of the patients with borderline hypoplastic left heart syndrome. There has been no late mortality, and two patients have required reoperation: one for recurrent distal aortic arch obstruction, and one for moderate-severe autograft insufficiency. Freedom from reoperation at 30 months is 89%. Aside from one patient with moderate autograft insufficiency and eight with mild regurgitation, all patients have trace or no aortic insufficiency at follow-up ranging from 1 to 38 months (median 22 months). The Ross procedure is an important advance in the treatment of aortic valve disease in pediatric patients. It is the only available replacement for the aortic valve that has growth potential, and there is ample evidence that the pulmonary autograft holds up well in the systemic circulation.
尽管自罗斯描述其使用自体肺动脉进行主动脉瓣置换术的技术以来已近30年，但直到最近，先天性心脏病患儿使用罗斯手术进行主动脉瓣置换才引起广泛关注。自1992年7月以来，我们对46例患者实施了罗斯手术，其中40例在手术时年龄小于或等于18岁。10例儿童患者的手术联合了Konno心室成形术，另外3例采用罗斯 - Konno手术对临界性左心发育不全综合征进行双心室修复。仅有的早期死亡病例是2例临界性左心发育不全综合征患者。没有晚期死亡病例，有2例患者需要再次手术：1例是复发性主动脉弓远端梗阻，另1例是中度至重度自体移植物功能不全。30个月时无需再次手术的比例为89%。除1例中度自体移植物功能不全和8例轻度反流患者外，在1至38个月（中位时间22个月）的随访中，所有患者主动脉瓣反流微量或无反流。罗斯手术是小儿主动脉瓣疾病治疗的一项重要进展。它是唯一具有生长潜力的主动脉瓣替代方法，并且有充分证据表明自体肺动脉在体循环中表现良好。
