Midterm results of the Ross procedure preserving the patient's aortic root
Midterm results of the Ross procedure preserving the patient's aortic root
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DOI：
10.1161/01.cir.0000087443.84392.32
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发表时间：
2003-09-09
期刊：
影响因子：
37.8
通讯作者：
Schmidtke, C
中科院分区：
文献类型：
--
作者：
Sievers, HH;Dahmen, G;Schmidtke, C
背景-自20世纪90年代初以来，自体肺动脉瓣主要作为独立根部植入，以减少主动脉瓣返流。但是，随着时间的推移，根部扩张存在一定的风险，可能会损害瓣膜功能。8年来，我们倾向于采用原始的冠状动脉下或内含技术来保留患者的根部，以抑制扩张。在245例患者（191例男性，54例女性）中进行了（n = 228）和纳入技术（n = 17），平均年龄45.7 ± 13.4（15 - 70）岁。基础主动脉瓣疾病为主动脉瓣关闭不全（n = 83）、狭窄（n = 48）、合并主动脉瓣疾病（n = 111）和急性心内膜炎（n = 19）。既往主动脉瓣手术n = 23。在平均随访29.4 +/- 24.7个月（553.7患者年）时进行末次随访检查（去年内），包括超声心动图。住院死亡n = 2，晚期死亡n = 4（均为非心源性）。2例患者失访（99%完成临床随访）。n = 7个瓣膜需要再次手术（自体移植：心内膜炎n = 1，错位n = 1，瓣叶脱垂n = 1;同种移植：狭窄n = 2，关闭不全n = 2）。自体移植物功能不全（AI）为AI 0，n = 154，AI I n = 66，AI II n = 8。跨自体移植物的最大/平均压差分别为6.6 +/- 3.4（2.1 - 25.9）/ 3.6 +/- 1.8（1.2 - 13.2）mm Hg。同种移植物功能不全为0，n = 167，I，n = 54，II，n = 9，III，n = 1。最大和平均跨移植血管压差为11.7 +/- 6.8（2.2 - 42.6）/ 6.2 +/- 3.8（1.2 - 24.5）mm Hg。心功能I级214例，II级19例，III级2例。显着的主动脉根部扩张没有observed.Conclusions -主动脉瓣置换术与肺自体移植物在subcoronary或列入技术提供了良好的血流动力学没有根扩张至少在中期术后期间。跨移植血管压差略有增加。长期的结果，特别强调肺同种移植是必要的。
Background - Since the early 1990s, the pulmonary autograft is predominantly implanted as a freestanding root for less aortic valve regurgitation is reported. However, there is a certain risk of dilatation of the root over time potentially impairing valve function. We favor since 8 years the original subcoronary or inclusion technique to preserve the root of the patient as a restrain to dilatation.Methods and Results - Between June 1994 and May 2002 the subcoronary ( n = 228) and inclusion technique ( n = 17) were performed in 245 patients (191 male, 54 female), mean age 45.7 +/- 13.4 (15 - 70) years. The underlying aortic valve disease was an aortic insufficiency in n = 83, stenosis in n = 48, a combined aortic valve disease in n = 111 and an acute endocarditis in n = 19 patients. Previous aortic valve surgery was performed in n = 23. Last follow-up investigations ( within last year) including echocardiography was performed at a mean follow-up of 29.4 +/- 24.7 months (553.7 patient years). Hospital mortality was n = 2, late mortality n = 4 ( all noncardiac). Two patients were lost to follow-up ( 99% complete clinical follow-up). Reoperations were necessary in n = 7 valves ( autograft: endocarditis n = 1, malpositioning n = 1, leaflet prolapse n = 1; homograft: stenosis n = 2, insufficiency n = 2). Autograft insufficiency ( AI) was AI 0 in n = 154, AI I n = 66, AI II n = 8. The maximum/mean pressure gradient across the autograft was 6.6 +/- 3.4 (2.1 to 25.9)/ 3.6 +/- 1.8 (1.2 to 13.2) mm Hg, respectively. Homograft insufficiency was 0 in n = 167, I in n = 54, II in n = 9, and III in n = 1. Maximum and mean transhomograft pressure gradients were 11.7 +/- 6.8 (2.2 to 42.6)/ 6.2 +/- 3.8 ( 1.2 to 24.5) mm Hg. Most patients were NYHA class I ( n = 214), class II ( n = 19), class III ( n = 2). Significant aortic root dilatation was not observed.Conclusions - Aortic valve replacement with a pulmonary autograft in the subcoronary or inclusion technique provides excellent hemodynamics with no root dilatation at least in a mid term postoperative period. Transhomograft pressure gradients are slightly increased. Longer term results with special emphasis on the pulmonary homograft are necessary.