儿童Ross手术：10年经验

The Ross operation in children: 10-year experience.

作者信息

Elkins R C, Knott-Craig C J, Ward K E, Lane M M

机构信息

Section of Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA.

出版信息

Ann Thorac Surg. 1998 Feb;65(2):496-502. doi: 10.1016/s0003-4975(97)01373-8.

DOI:10.1016/s0003-4975(97)01373-8

PMID:9485253

Abstract

BACKGROUND

The Ross operation, first performed in children in 1968, may be the ideal aortic valve replacement. Technical demands of the operation and two valves at risk have delayed acceptance. A review of our experience to assess midterm and long-term results with the Ross operation is presented.

METHODS

The records of 150 consecutive patients, aged 7 days to 21 years (median age, 12 years, 75% less than 15 years) were reviewed. Follow-up was complete within the last 12 months (median, 2.8 years; range, 1 month to 10 years). Echocardiographic assessment was available on 116 (71%) within 1 year of closure and in 136 (91%) within 2 years.

RESULTS

Survival was 97.3% at 8 years. Late autograft valve dysfunction required replacement in 2 and reoperation with restitution of autograft function in 6. Freedom from reoperation for autograft dysfunction is 90% +/- 4% at 8 years. Freedom from reoperation for homograft obstruction is 94% +/- 3% at 8 years. Pulmonary homograft dysfunction (gradient > 40 mm Hg) was present in 4 additional patients. Freedom from reoperation on the homograft or a gradient of 40 mm Hg is 89% +/- 4% at 8 years. All patients have a normal, active lifestyle, without anticoagulants for their aortic valve replacement.

CONCLUSIONS

The Ross operation is the preferred operative replacement in children requiring aortic valve replacement.

摘要

背景

罗斯手术于1968年首次应用于儿童，可能是理想的主动脉瓣置换术。该手术的技术要求以及两个瓣膜面临的风险延缓了其被广泛接受的进程。本文回顾了我们应用罗斯手术评估中期和长期结果的经验。

方法

回顾了150例连续患者的记录，年龄从7天至21岁（中位年龄12岁，75%小于15岁）。随访在过去12个月内完成（中位时间2.8年；范围1个月至10年）。116例（71%）在关闭后1年内有超声心动图评估结果，136例（91%）在2年内有评估结果。

结果

8年生存率为97.3%。晚期自体瓣膜功能障碍导致2例需要置换，6例再次手术恢复自体瓣膜功能。8年时自体瓣膜功能障碍无需再次手术的比例为90%±4%。8年时同种异体瓣膜梗阻无需再次手术的比例为94%±3%。另外4例患者存在肺动脉同种异体瓣膜功能障碍（压差>40 mmHg）。8年时同种异体瓣膜无需再次手术或压差<40 mmHg的比例为89%±4%。所有患者都有正常、积极的生活方式，主动脉瓣置换术后无需抗凝。