Jaggers J, Harrison J K, Bashore T M, Davis R D, Glower D D, Ungerleider R M
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Ann Thorac Surg. 1998 Jun;65(6):1553-7; discussion 1557-8. doi: 10.1016/s0003-4975(98)00288-4.
The Ross procedure has become an accepted and sometimes preferred alternative to mechanical aortic valve replacement. One criticism of the Ross procedure is that it may have a higher operative mortality, morbidity, and cost. Several groups have shown that this operation can be performed safely with less than 3% mortality. The issue of higher cost has not been resolved. In this retrospective study we compared a consecutive group of patients undergoing the Ross procedure with an age- and disease-matched group of patients who underwent mechanical aortic valve replacement.
From 1993 to 1996, 22 consecutive adult patients (age range, 20 to 57 years; mean, 38 +/- 14 years) underwent the Ross procedure. Twenty-seven patients (age range, 17 to 57 years; mean, 41 +/- 10 years) underwent mechanical aortic valve replacement between 1991 and 1996. The hospital cost (in 1996 dollars) and postoperative length of stay were calculated for each patient using Transition I, a hospital-wide cost accounting system.
There was no hospital mortality in either group. The incidence of significant valve-related complication was 5% (1/22 patients) in the Ross procedure group and 22% (6/27 patients) in the mechanical valve group. There were two late deaths in the group with mechanical aortic valve replacement. The length of stay for the Ross procedure group was 5.9 +/- 2.1 days, versus 8 +/- 1.85 days for the mechanical valve group (p < 0.01). The mean hospital costs were not significantly different, $23,140 +/- $7,825 for the mechanical valve group and $23,226 +/- $6,960 for the group having the Ross procedure.
The data from this review demonstrate that the Ross procedure can be done safely, with short hospital stays, decreased morbidity, and costs comparable with those of standard mechanical aortic valve replacement in patients with isolated aortic valve disease.
罗斯手术已成为一种被认可且有时更受青睐的替代机械主动脉瓣置换术的方法。对罗斯手术的一项批评是，它可能具有更高的手术死亡率、发病率和成本。多个研究小组表明，该手术可以安全进行，死亡率低于3%。更高成本的问题尚未得到解决。在这项回顾性研究中，我们将一组连续接受罗斯手术的患者与一组年龄和病情匹配、接受机械主动脉瓣置换术的患者进行了比较。
1993年至1996年，连续22例成年患者（年龄范围20至57岁；平均38±14岁）接受了罗斯手术。1991年至1996年期间，27例患者（年龄范围17至57岁；平均41±10岁）接受了机械主动脉瓣置换术。使用全院成本核算系统Transition I计算每位患者的医院成本（以1996年美元计）和术后住院时间。
两组均无医院死亡病例。罗斯手术组严重瓣膜相关并发症的发生率为5%（1/22例患者），机械瓣膜组为22%（6/27例患者）。接受机械主动脉瓣置换术的组中有两例晚期死亡。罗斯手术组的住院时间为5.9±2.1天，而机械瓣膜组为8±1.85天（p<0.01）。平均医院成本无显著差异，机械瓣膜组为23,140±7,825美元，接受罗斯手术的组为23,226±6,960美元。
本综述的数据表明，对于单纯主动脉瓣疾病患者，罗斯手术可以安全进行，住院时间短，发病率降低，且成本与标准机械主动脉瓣置换术相当。
