单中心Ross手术长期随访总结  

Long-term follow-up with Ross procedure at a single institution

作　　者：石秋霞[1] 徐志伟[1] 侯晓彤[1] 贾明[1] 李温斌[1] Shi Qiuxia, Xu Zhiwei, Hou Xiaotong, Jia Ming, Li Wenbin(Critical Care Center of the Cardiac Surgery, Capital Medical University Affiliated Belting Anzhen Hospital, Beifing Institute of Heart, Lung and Blood Vessel Disease, Beifing 100029, Chin)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心,100029

出　　处：《中华胸心血管外科杂志》2018年第3期157-160,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨Ross手术的长期随访结果。方法回顾性分析1994年10月至2009年2月58例Ross手术患者手术及随访资料。结果58例患者随访4．5-18．2年，平均（12．6±5．8）年。2例早期死亡（3％），Ⅰ例晚期死亡（2％）。16年实际生存比例（94．3±3．1）％。其中1例术后1．5年二次手术，术中死亡。55例生存患者中42例（76％）心功能Ⅰ级（NYHA分级），13例（24％）心功能Ⅱ级。术后1年，7例患者（12％）自体置换瓣膜出现1-2级反流，主动脉窦直径均≤40mm。术后20年未出现血流相关性自体置换瓣膜反流的比例为（87．9±2．8）％，患者左心室功能显著改善，左心室舒张期末径逐步恢复到正常水平，未出现肺动脉自体置换瓣膜毁损病例。结论Ross手术治疗主动脉瓣疾病安全有效。手术及随访中需要注意主动脉瓣和肺动脉瓣直径相匹配；控制收缩压在120mmHg（1mmHg=0．133kPa）以下，并尽可能控制心率于低水平，以延缓肺动脉瓣自体置换物的毁损。Objective To study the long-term follow-up results of Ross surgery. Methods Between October 1994 and February 2009, 58 consecutive patients underwent a Ross procedure at our institution. The right ventricular outflow tract was repaired with a cryopreserved pulmonary homograft. All patients were scheduled for a yearly study thereafter that ended at the time of death or at closure of the follow-up visit. Mean follow-up was（ 12.6 ± 5.8 ） years（ range ： 4.5 to 18.2 years）. Results There were two early deaths（3% ） and one late death（2% ）. Acturial survival at 16 years was（94.8 ±3.1 ） %. One patient required reoperation 1.5 years after his first Ross operation. Of the 55 survival patients, 42 patients（76% ） were in NYHA functional class I and 13 patients（24% ） were in NYHA functional class Ⅱ. Grade 1 or grade 2 autograft regurgitation was observed in seven patients（ 12% ） at one year after the surgery. The sinus of Valsalva diameters were all 〈40 mm in these seven patients. After surgery, freedom from hemodynamically relevant autograft regurgitation was （87.9±2.8 ）% at 16 years, whose left ventricular function was significantly improved and left ventricular end-diastolic diameter recovered to normal over the long term. None of the patients required reoperation due to pulmonary homograft failure. Conclusion The Ross procedure can be safely performed in patients with aortic valve disease. To date, mortality, morbidity, and reoperation relates are very low. Reasons for these superior results may include the following： diameter of the aortic valve annulus matching that of the pulmonary valve and patients were monitored with antihypertensive medications to keep systolic blood pressure under 120mmHg（ 1 mmHg = 0. 133kPa） to delay pressure lesions to the pulmonary autograft.

关 键 词：主动脉根部 心脏瓣膜假体置入 肺动脉瓣 

分 类 号：R654.2[医药卫生—外科学]