Stelzer P, Weinrauch S, Tranbaugh R F
Division of Cardiac Surgery, Beth Israel Medical Center, New York City, NY 10003, USA.
J Thorac Cardiovasc Surg. 1998 May;115(5):1091-100. doi: 10.1016/S0022-5223(98)70409-X.
To assess the full root modification of the Ross procedure, we examined operative and long-term results.
We retrospectively reviewed 145 patients (118 men and 27 women) operated on from March 1987 through April 1997. Ages ranged from 17 to 68 years. Primary diagnosis was aortic stenosis in 43 patients (29.6%) and aortic regurgitation in 62 patients (42.8%). There was mixed disease (stenosis and regurgitation) in 40 patients (29.6%) of whom the vast majority had predominant stenosis.
Early death was 7 of 145 patients (4.8%). Twelve patients had 14 significant complications (8.5%). There were four late deaths. Overall patient survival is 90.5% +/- 3.1% at 5 years and 84.5% +/- 14.1% at 7 years. Endocarditis occurred in three patients-two on the autograft and one on the pulmonary homograft. Three patients had cerebrovascular accidents. In 5 of 132 patients (3.8%) reoperations were required on the autograft. Freedom from autograft reoperation was 93.9% +/- 3.1% at 5 years and 88.6% +/- 6.4% at 7 years. Echocardiographic follow-up reveals more than mild aortic regurgitation in only nine patients, including the five patients in whom reoperations were required. Seven of 11 patients with active endocarditis at the time of the operation had adverse outcomes.
Ten years' experience with the modified Ross procedure has shown excellent results with regard to short- and long-term morbidity and death. It is the procedure of choice for young patients who need aortic valve replacement but should be used with caution in the setting of active endocarditis.
为评估罗斯手术的全根部改良情况，我们对手术及长期结果进行了研究。
我们回顾性分析了1987年3月至1997年4月期间接受手术的145例患者（118例男性和27例女性）。年龄范围为17至68岁。主要诊断为主动脉狭窄43例（29.6%），主动脉瓣关闭不全62例（42.8%）。40例（29.6%）患者存在混合性病变（狭窄和关闭不全），其中绝大多数以狭窄为主。
145例患者中有7例早期死亡（4.8%）。12例患者出现14项严重并发症（8.5%）。有4例晚期死亡。总体患者生存率在5年时为90.5%±3.1%，在7年时为84.5%±14.1%。3例患者发生心内膜炎，2例发生在自体移植物，1例发生在肺同种异体移植物。3例患者发生脑血管意外。132例患者中有5例（3.8%）需要对自体移植物进行再次手术。自体移植物再次手术的无复发生存率在5年时为93.9%±3.1%，在7年时为88.6%±6.4%。超声心动图随访显示，仅9例患者存在轻度以上主动脉瓣反流，其中包括5例需要再次手术的患者。手术时11例活动性心内膜炎患者中有7例预后不良。
改良罗斯手术十年的经验表明，在短期和长期发病率及死亡率方面效果良好。对于需要主动脉瓣置换的年轻患者而言，这是首选手术方式，但在活动性心内膜炎情况下应谨慎使用。
