Pettersson G, Tingleff J, Joyce F S
Department of Cardiothoracic Surgery, Copenhagen University Hospital-Rigshospitalet, Denmark.
Eur J Cardiothorac Surg. 1998 Jun;13(6):678-84. doi: 10.1016/s1010-7940(98)00053-0.
Standard treatment of patients with infective endocarditis is radical debridement and valve replacement, in cases with advanced pathology the treatment is usually root replacement with either a composite graft or a homograft. Enthusiasm for the use of the Ross operation in non-infective aortic valve disease is increasing, but use of the pulmonary autograft in the treatment of aortic valve endocarditis has been limited. The objective of this prospective study is to present the technique and results of our experience with aortic valve endocarditis treated with the Ross operation.
Since 1992 we have treated 35 patients (median age 41 years, range 6-71 years) having aortic valve endocarditis with a Ross operation. Twenty-four patients had advanced disease defined as pathology due to endocarditis extending beyond the valve cusps (13 patients) or prosthetic valve endocarditis (11 patients). Twenty-two patients had active disease at the time of surgery, and 12 had undergone one to four previous heart operations.
There were two operative deaths (5.8%), both related to severe disease with very advanced pathology and heart failure. Intraoperative echocardiography demonstrated no or trivial autograft insufficiency in all patients. There have been no late deaths. There has been one (probable) recurrent right-sided endocarditis in a drug addict during a follow-up period of 3-56 months. One patient has been reoperated on for homograft stenosis.
We are enthusiastic about the use of the Ross operation in aortic valve endocarditis and in younger patients with advanced pathology, it is our preferred treatment modality. Following removal of the autograft, unparalleled exposure of the left ventricular outflow tract is obtained. Even in patients with very advanced pathology the left ventricular outflow tract is usually intact, allowing autograft implantation in the standard fashion. For selected patients with simple endocarditis, the Ross operation is an attractive option on its usual merits.
感染性心内膜炎患者的标准治疗方法是进行彻底清创和瓣膜置换，对于病变严重的病例，通常采用复合移植物或同种异体移植物进行根部置换。在非感染性主动脉瓣疾病中，使用罗斯手术（Ross手术）的热情日益高涨，但肺动脉自体移植物在主动脉瓣心内膜炎治疗中的应用一直有限。这项前瞻性研究的目的是介绍我们采用罗斯手术治疗主动脉瓣心内膜炎的技术及经验结果。
自1992年以来，我们采用罗斯手术治疗了35例主动脉瓣心内膜炎患者（中位年龄41岁，范围6 - 71岁）。24例患者患有严重疾病，定义为心内膜炎导致的病变超出瓣膜叶（13例患者）或人工瓣膜心内膜炎（11例患者）。22例患者在手术时患有活动性疾病，12例患者此前接受过一至四次心脏手术。
有2例手术死亡（5.8%），均与病变非常严重且伴有心力衰竭的重症疾病有关。术中超声心动图显示所有患者的自体移植物均无或仅有轻微关闭不全。无晚期死亡病例。在3 - 56个月的随访期内，1例吸毒者出现了1次（可能的）右侧复发性心内膜炎。1例患者因同种异体移植物狭窄接受了再次手术。
我们对在主动脉瓣心内膜炎中使用罗斯手术充满热情，对于病变严重的年轻患者，这是我们首选的治疗方式。切除自体移植物后，可以无与伦比地暴露左心室流出道。即使是病变非常严重的患者，左心室流出道通常也保持完整，允许以标准方式植入自体移植物。对于部分单纯性心内膜炎患者，罗斯手术因其通常具备的优点而成为一个有吸引力的选择。
