The Pulmonary Autograft After the Ross Operation: Results of 25-Year Follow-Up in a Pediatric Cohort
The Pulmonary Autograft After the Ross Operation: Results of 25-Year Follow-Up in a Pediatric Cohort
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DOI：
10.1016/j.athoracsur.2020.06.027
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发表时间：
2021-01-01
影响因子：
4.6
通讯作者：
Poncelet, Alain
中科院分区：
文献类型：
--
作者：
Bove, Thierry;Bradt, Nicolas;Poncelet, Alain
背景进行性自体移植物扩张和后期再次手术的需要仍然是Ross手术的主要问题。该研究调查了Ross手术后的临床结果，包括25年来自体移植物尺寸的纵向分析。从1991年11月至2019年4月，137名患者在UCL大学医院（Universite catholique de Louvain-Brussels和根特）接受了Ross手术。入选标准为小于或等于18岁，通过牙根置换术植入肺自体移植物。通过线性混合模型分析，结果集中在生存率、再手术率和自体移植物大小的变化。110例（80%）和27例（20%）患者接受了Ross或Ross-Konno手术，中位年龄分别为10.4（四分位距= IQR，4.7-14.3）岁和0.5（IQR，0.04-5.2）岁。总体10年和20年生存率分别为87% +/- 3%和85% +/-3%，但孤立的Ross患者为93% +/- 3%。20.3%的患者需要右心室流出道-管道交换，而14例（10.7%）患者在中位间隔14（IQR，9-16）年时因主动脉瓣返流（n = 2）和自体移植物扩张（n = 12）进行了自体移植物相关的再次手术。与瓣环相比，窦和窦管交界处（STJ）的自体移植物z值显著增加（瓣环= 0.05 +/- 0.38/y，窦= 0.14 +/- 0.25/y，STJ = 0.17 +/- 0.34/y; P = 0.015）。Ross-Konno与Ross患者相比，自体移植物尺寸的z值斜率明显更陡（环：P = .029;窦：P < .001; STJ：P = .012），并且对于主动脉弓修复的儿童（环：P = .113，窦：P = .038; STJ：P = .029）。Ross手术为需要主动脉瓣置换的儿童提供了极好的生存前景，在前25年内自体移植物再次手术的风险可接受。与自体瓣环相反，窦扩张和STJ尺寸值得关注。在接受Ross-Konno手术或主动脉弓重建的患者中，可能需要更密切地监测自体移植物的尺寸。(C)2021年美国胸外科医师协会
Background. Progressive autograft dilation and need for later reoperation remain major concerns of the Ross procedure. The study investigates the clinical outcome after the Ross operation, including a longitudinal analysis of autograft dimensions over 25 years.Methods. From November 1991 to April 2019, 137 patients underwent a Ross procedure at the University Hospitals of UCL (Universite catholique de Louvain-Brussels and Ghent. Inclusion criteria were less than or equal to 18 years of age and pulmonary autograft implantation by root replacement. Outcome focused on survival, reoperation rate, and autograft size evolution through linear mixed-model analysis.Results. A Ross or Ross-Konno operation was performed in 110 (80%) and 27 (20%) patients at a median age of 10.4 (interquartile range = IQR], 4.7-14.3) years and 0.5 (IQR, 0.04-5.2) years, respectively. Overall 10-year and 20-year survival was 87% +/- 3% and 85% +/- 3%, respectively, but was 93% +/- 3% for isolated Ross patients. Right ventricular outflow tract-conduit exchange was required in 20.3%, whereas autograftrelated reoperation was performed in 14 (10.7%) patients at a median interval of 14 (IQR, 9-16) years, for aortic regurgitation (n = 2) and autograft dilation (n = 12). Autograft z-values increased significantly at the sinus and sinotubular junction (STJ) compared with the annulus (annulus = 0.05 +/- 0.38/y, sinus = 0.14 +/- 0.25/y, STJ = 0.17 +/- 0.34/y; P = .015). The z-value slope for autograft dimensions was significantly steeper for Ross-Konno vs Ross patients (annulus: P = .029; sinus: P < .001; STJ: P = .012), and for children having aortic arch repair (annulus: P = .113, sinus: P = .038; STJ: P = .029).Conclusions. The Ross operation offers children requiring aortic valve replacement an excellent survival perspective, with an acceptable risk of autograft reoperation within the first 25 years. Contrary to the autograft annulus, dilation of the sinus and STJ size is of concern. Closer surveillance of autograft dimensions might be required in patients who underwent a Ross-Konno procedure or aortic arch reconstruction. (C) 2021 by The Society of Thoracic Surgeons