摘要
背景:自体移植手术作为一种主动脉瓣置换方法,已经历了技术发展。许多有关Ross手术中最适合手术技术的争论仍在继续。最初被描述为冠状动脉下移植的完整根部置换技术是目前最为常用的实施Ross原理的技术。方法和结果:1994年6月至2005年6月,对347例患者实施了最初的冠状动脉下自体移植技术。收集并分析术前、围手术期以及随访的数据。患者移植时的年龄为44±13岁(极差14～71;273例男性,74例女性)。
BACKGROUND -The autograft procedure, an option in aortic valve replacement, has undergone technical evolution. A considerable debate about the most favorable surgical technique in the Ross operation is still ongoing. Originally described as a subcoronary implant, the full root replacement technique is now the most commonly used technique to perform the Ross principle. METHODS AND RESULTS -Between June of 1994 and June of 2005, the original subcoronary autograft technique was performed in 347 patients. Preoperative, perioperative, and follow-up data were collected and analyzed. Mean patient age at implantation was 44±13 years(range 14 to 71 years; 273 male, 74 female). Bicuspid valve morphology was present in 67%. The underlying valve disease was aortic regurgitation in 111 patients, stenosis in 46 patients, combined lesion in 188 patients, and active endocarditis in 22 patients(in 2 patients without stenosis or regurgitation). Concomitant procedures were performed in 130 patients. Clinical and echocardiographic follow-up visits were obtained annually(mean follow up 3.9±2.7 years, 1324 patient-years; completeness of follow up 99.4%). The in-hospital mortality rate was 0.6%(n=2), and the late mortality was 1.7%(n=6), with 5 noncardiac deaths(4 cancer, 1 multiorgan failure after noncardiac surgery) and 1 cardiac death(sudden death). At last follow-up, 94%of the surviving patients were in New York Heart Association class I. Ross procedure-related valvular reoperations were necessary in 9 patients: Three received autograft explants, 5 received homograft explants, and 1 received a combined auto-and homograft explant. At last follow-up visit, autograft/homograft regurgitation grade II was present in 5/10 patients and grade III in 4/0. Maximum/mean pressure gradients were 7.4±6.2/3.7±2.1 mm Hg across the autograft and 15.3±9.4/7.6±5.0 mm Hg across the right ventricular outflow tract, respectively. Aortic root dilatation was not observed. Freedom from any valve-related intervention was 95%at 8 years(95%confidence in
