Long-Term Survival and Reintervention After the Ross Procedure Across the Pediatric Age Spectrum
Long-Term Survival and Reintervention After the Ross Procedure Across the Pediatric Age Spectrum
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DOI：
10.1016/j.athoracsur.2015.02.068
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发表时间：
2015-06-01
影响因子：
4.6
通讯作者：
Hirsch-Romano, Jennifer C.
中科院分区：
文献类型：
--
作者：
Nelson, Jennifer S.;Pasquali, Sara K.;Hirsch-Romano, Jennifer C.
背景关于儿童Ross手术后的长期结果的数据有限。我们在一个大型儿科队列中评估了死亡率和再干预。对1991年至2013年在我院接受Ross手术的所有18岁以下患者进行了回顾性分析。采用Kaplan-Meier曲线和考克斯比例风险模型评价长期预后和相关危险因素。纳入了240例接受Ross/Ross-Konno手术的连续患者：18%为婴儿，48%为儿童，33%为青少年。婴儿更可能患有复杂的左心脏病（p = 0.005）。出院的总生存率为96%;婴儿死亡率最高（18%）。长期生存率为99.6%（中位随访时间为10.7年）。总体15年生存率为87%（婴儿最低，72%; p = 0.003）。87%的患者知道再次介入状态。总体而言，15年无任何左心室流出道再介入的比率为59%; 85%的患者在最近一次随访时仍有自体移植瓣膜。左心室流出道再介入在婴儿中不常见（n = 2）。15年内无右心室流出道再介入的总比率为53%，婴儿（19%）低于儿童（51%）和青少年（76%; p <0. 0001）。儿童罗斯手术后的结果因年龄而异。婴儿更常见复杂的左心脏病和经历更高的死亡率，但具有良好的长期自体移植耐久性。儿童和青少年的左心室流出道再介入率较高，而婴儿的右心室流出道再介入风险最高。(C)2015年美国胸外科医师协会
Background. There are limited data regarding long-term outcomes after the Ross procedure in children. We evaluated mortality and reintervention in a large pediatric cohort.Methods. A retrospective analysis of all patients aged younger than 18 years who underwent the Ross procedure at our institution (1991 to 2013) was conducted. Kaplan-Meier curves and Cox proportion hazard models were used to evaluate long-term outcomes and associated risk factors.Results. Included were 240 consecutive patients under-going a Ross/Ross-Konno procedure: 18% infants, 48% children, and 33% adolescents. Infants were more likely to have complex left heart disease (p = 0.005). Overall survival to hospital discharge was 96%; infants had the highest mortality (18%). Long-term survival status was known for 99.6% (median follow-up, 10.7 years). Overall 15-year survival was 87% (lowest in infants, 72%; p = 0.003). Reintervention status was known in 87%. Overall 15-year freedom from any left ventricular outflow tract reintervention was 59%; 85% still had their autograft valve at the latest follow-up. Left ventricular outflow tract reintervention was uncommon in infants (n = 2). Overall 15-year freedom from right ventricular outflow tract reintervention was 53%, and was lower in infants (19%) than in children (51%) and adolescents (76%; p < 0.0001).Conclusions. Outcomes after the Ross procedure in children vary by age. Infants more commonly have complex left heart disease and experience higher mortality but have excellent long-term autograft durability. Children and adolescents have higher rates of left ventricular outflow tract reintervention, whereas infants are at highest risk of right ventricular outflow tract reintervention. (C) 2015 by The Society of Thoracic Surgeons