The Ross operation: a 12-year experience.
The Ross operation: a 12-year experience.
复制标题
罗斯手术：12 年的经验。
DOI：
10.1016/s0003-4975(99)00841-3
复制
发表时间：
1999
影响因子：
4.6
通讯作者：
Ronald C. Elkins
中科院分区：
文献类型：
--
作者：
Ronald C. Elkins
背景Ross手术最初作为一种扇形冠状动脉下植入物引入，其存活率为80%，85%免于再次手术，最近已被修改为牙根置换，这是目前最常用的植入技术。本文报告了该手术技术的中期和晚期结果，并比较了主动脉内植入物和根置换术在一个机构中的效果。对1986年8月至1998年7月期间的手术技术和患者相关因素进行了回顾性分析，以评估手术技术和患者相关因素对生存率、自体瓣膜功能、同种瓣膜功能结果手术生存率为95. 4%，8年生存率为89% ± 5%。8年时无肺自体移植物置换率为94% ± 3%，8年时无肺同种移植物再次手术率为90% ± 4%，9年时无自体移植物瓣膜再次手术或功能障碍（3+自体移植物瓣膜功能不全）率为83% ± 6%。自体瓣膜再手术和晚期自体瓣膜功能障碍的发生率通过根部置换降低。瓣环复位和固定改善了主动脉瓣关闭不全和瓣环扩张患者的早期结果。良好的血流动力学结果以及有限的再手术和自体移植瓣膜置换率证明了其继续使用的合理性。
BackgroundThe Ross operation, originally introduced as a scalloped subcoronary implant with an 80% survival and 85% freedom from reoperation, has recently been modified to a root replacement which is now the most utilized implant technique. The mid and late results of this operative technique and comparison of intra-aortic implants and root replacement in a single institution are reported.MethodsThe records of 328 patients who had a Ross operation at the University of Oklahoma (August 1986 to July 1998) were reviewed to assess operative technique and patient-related factors on survival, autograft valve function, homograft valve function, valve-related complications, and need for reoperation.ResultsOperative survival was 95.4% with an actuarial survival of 89% ± 5% at 8 years. Freedom from replacement of the pulmonary autograft was 94% ± 3% at 8 years, freedom from reoperation on the pulmonary homograft was 90% ± 4% at 8 years, and freedom from autograft valve reoperation or dysfunction (3+ autograft valve insufficiency) was 83% ± 6% at 9 years. The incidence of autograft valve reoperation and late autograft valve dysfunction was decreased by root replacement. Annulus reduction and fixation improved early results in patients with aortic insufficiency and annulus dilatation.ConclusionsEarly results have been excellent, as the development of late autograft valve dysfunction or dilatation has been rare. The excellent hemodynamic results with a limited incidence of reoperation and replacement of the autograft valve justify its continued use.