Ross Procedures in Children With Previous Aortic Valve Surgery
Ross Procedures in Children With Previous Aortic Valve Surgery
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DOI：
10.1016/j.jacc.2020.07.058
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发表时间：
2020-09-29
影响因子：
24
通讯作者：
Konstantinov, Igor E.
中科院分区：
文献类型：
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作者：
Buratto, Edward;Wallace, Fraser R. O.;Konstantinov, Igor E.
背景 儿童Ross手术可以作为初次手术，也可以作为初次主动脉瓣手术后的二次手术。 目的 本研究旨在确定初次Ross手术和二次Ross手术的结果是否相似。 方法 本研究纳入了1995年至2018年期间接受Ross手术的所有患者。对主动脉瓣手术后接受初次罗斯手术的患者和接受二次罗斯手术的患者的结果进行了比较。对基线特征以及死亡和再次手术的危险因素进行倾向评分匹配。 结果 在 140 例 Ross 手术中，51.4%（140 例中的 n=72）为初次手术，而 48.6%（140 例中的 n=68）为二次手术。接受初次 Ross 手术的患者往往年龄较大（中位年龄 8.6 岁 vs. 7.0 岁；p = 0.10）并且体重较高（28.9 kg vs. 19.4 kg；p = 0.07）。在未匹配的队列中，生存率或免于再次手术的情况没有显着差异。倾向评分匹配产生了 50 个匹配良好的配对。在匹配队列中，初级 Ross 组的 10 年生存率为 90.0%（95% 置信区间 [CI]：77.5% 至 95.7%），而次级 Ross 组的 10 年生存率为 96.8%（95% CI：79.2% 至 99.5%）（p = 0.04）。初次 Ross 组 10 年免于自体移植物再次手术的比例为 82%（95% CI：64.1% 至 91.5%），而二次 Ross 组的比例为 97.0%（95% CI：80.4% 至 99.6%）（p = 0.03）。 结论 初次主动脉瓣手术后进行的二次 Ross 手术可实现更高的远期生存率和免于自体移植物与初次罗斯手术相比，再次手术。初步主动脉瓣修复，然后延迟罗斯手术的策略可能会提供更好的长期生存率，并且免于自体移植物再次手术。皇冠版权所有 (C) 2020 由爱思唯尔代表美国心脏病学会基金会出版。版权所有。
BACKGROUND The Ross procedure in children is performed either as a primary operation, or a secondary operation after initial aortic valve surgery.OBJECTIVES The study aimed to determine whether the outcomes of primary and secondary Ross procedure are similar.METHODS All patients who underwent Ross procedure between 1995 and 2018 were included in the study. Outcomes were compared between those who had primary Ross procedure and those who had secondary Ross procedure, after aortic valve surgery. Propensity score matching for baseline characteristics and risk factors for death and reoperation was performed.RESULTS Of 140 Ross procedures, 51.4% (n=72 of 140) were primary operations, while 48.6% (n=68 of 140) were secondary operations. Patients undergoing primary Ross procedure tended to be older (median age 8.6 years vs. 7.0 years; p = 0.10) and have a higher weight (28.9 kg vs. 19.4 kg; p = 0.07). There were no significant differences in survival or freedom from reoperation in the unmatched cohort. Propensity score matching resulted in 50 well-matched pairs. In the matched cohort, survival at 10 years was 90.0% (95% confidence interval [CI]: 77.5% to 95.7%) in the primary Ross group, compared with 96.8% (95% CI: 79.2% to 99.5%) in the secondary Ross group (p = 0.04). Freedom from autograft reoperation at 10 years was 82% (95% CI: 64.1% to 91.5%) in the primary Ross group, compared with 97.0% (95% CI: 80.4% to 99.6%) in the secondary Ross group (p = 0.03).CONCLUSIONS Secondary Ross procedure performed after initial aortic valve surgery achieves superior tong-term survival and freedom from autograft reoperation compared with primary Ross procedure. A strategy of initial aortic valve repair followed by delayed Ross procedure may provide better tong-term survival and freedom from autograft reoperation. Crown Copyright (C) 2020 Published by Elsevier on behalf of the American College of Cardiology Foundation. All rights reserved.