Ross术在儿童及青少年中应用的早期效果  

Early results of Ross procedure in children and adolescents

作　　者：吴铸衡 谢林[1] 吕璟 赁可[1] Wu Zhuheng;Xie Lin;Lyu Jing;Lin Ke(Department of Cardiovascular Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Anesthesia Surgery Center,West China Hospital,Chengdu 610041,China)

机构地区：[1]四川大学华西医院心脏大血管外科,成都610041 [2]四川大学华西医院麻醉手术中心,成都610041

出　　处：《中华心脏与心律电子杂志》2024年第4期212-218,共7页Chinese Journal of Heart and Heart Rhythm(Electronic Edition)

摘　　要：目的探究儿童及青少年中自体肺动脉瓣移植术(Ross术)的早期矫治效果,初步探索患者的术后结局与手术策略间的关联。方法连续纳入四川大学华西医院2019年1月至2023年9月行Ross术的儿童及青少年患者,收集患者主动脉瓣病变类型、程度等术前基线资料,手术方式、手术时间等术中资料及主动脉瓣反流程度、跨瓣压差等术后随访资料,并进行了数据汇总及分析。结果共24例儿童及青少年患者接受了Ross术,年龄(12.6±6.4)岁,其中男占50.0%(12/24)。17(70.8%,17/24)例患者为主动脉瓣二叶式畸形,主动脉瓣狭窄为主要的瓣膜病变类型(45.8%,11/24)。12(50.0%,12/24)例患者采用根部置换策略,10(41.7%,10/24)例采用冠状动脉(冠脉)下再植策略,另有2例分别采用外部加固策略和嵌套策略。围手术期未发生死亡事件,根部置换组手术时间显著长于冠脉下再植组[(487.5±106.7)min对(382.1±57.2)min,P=0.027],但两组在阻断时间、体外循环时间及重症监护室住院时间方面差异无统计学意义。患者术后随访时间为(20.4±17.9)个月,所有患者均生存。术后17(70.8%,17/24)例患者为心功能Ⅰ级[纽约心脏协会(NYHA)分级],5(20.8%,5/24)例为心功能Ⅱ级,2(8.3%,2/24)例为心功能Ⅲ级。术后患者主动脉瓣前向血流速度为(1.3±0.4)m/s,无患者存在中度及以上主动脉瓣反流。术后患者肺动脉瓣前向血流速度为(2.3±1.0)m/s,2(8.3,2/24%)例患者存在中度及以上肺动脉瓣反流(均为Gore-Tex带瓣管道重建)。3(12.5%,3/24)例患者分别于术后9、10及30个月接受右心再手术。结论Ross术可在儿童及青少年中取得较为理想的早期效果。除手术时间外,根部置换组和冠脉下再植组的矫治结局无明显差异。在右心室流出道的重建方面,应慎重选择重建材料以降低再手术风险。Objective To explore the early outcomes of pulmonary autograft replacement procedure(Ross procedure)in children and adolescents in our center,and the relationship between postoperative outcomes and surgical strategies.Method Children and adolescents who underwent Ross surgery in West China Hospital,Sichuan University from January 2019 to September 2023 were continuously included.Baseline data such as the type and severity of patients'aortic valve lesions,intraoperative data such as surgical strategies and time,and postoperative follow-up data such as the degree of aortic regurgitation and transvalvular pressure gradients were retrospectively collected and statistical analyzed.Results A total number of 24 children and adolescents received Ross procedure in our center,and their mean age was(12.6±6.4)years,and 12(50.0%,12/24)of them were male.17 patients(70.8%,17/24)had a bicuspid aortic valve,and aortic stenosis was the main pathological change of the aortic valve(11/24,45.8%).12 patients(50.0%,12/24)received the Ross procedure with the Root replacement technique,and 10(41.7%,10/24)with the Subcoronary technique,while the other 2 with reinforcement technique and Inclusion technique respectively.There was no perioperative death,the operative time of Root replacement group was significantly longer than that of the Subcoronary group[(487.5±106.7)min vs.(382.1±57.2)min,P=0.027],while the corss-clamp time,bypass time and intensive care unit(ICU),stay were comparable between groups.The mean follow-up time was(20.4±17.9)months,with no late mortality.17 patients(70.8%,17/24)were classified as New York Heart AssociationⅠ,and 5(20.8%,5/24)were classified as New York Heart Association(NYHA)Ⅱ,while it was NYHAⅢfor the other 2(8.3%).Postoperative antegrade flow velocity for aortic valve was(1.3±0.4)m/s,and no patient developed moderate or more aortic regurgitation postoperatively.Postoperative antegrade flow velocity for pulmonary valve was(2.3±1.0)m/s,and there were 2 patients who developed moderate or more pu

关 键 词：肺动脉瓣 自体肺动脉瓣移植术 Ross术 主动脉瓣病变 儿童 青少年 再手术 

分 类 号：R726.5[医药卫生—儿科]