Is the Ross Procedure a Suitable Choice for Aortic Valve Replacement in Children With Rheumatic Aortic Valve Disease?

被引:14
作者
Alsoufi, Bahaaldin [1 ]
Manlhiot, Cedric [2 ,3 ]
Fadel, Bahaa [1 ]
Al-Fayyadh, Majid [1 ]
McCrindle, Brian W. [2 ,3 ]
Alwadai, Abdullah [1 ]
Al-Halees, Zohair [1 ]
机构
[1] King Faisal Specialist Hosp & Res Ctr, King Faisal Heart Inst, MBC 16,POB 3354, Riyadh, Saudi Arabia
[2] Hosp Sick Children, Labatt Family Heart Ctr, Toronto, ON, Canada
[3] Univ Toronto, Toronto, ON, Canada
关键词
aortic regurgitation; aortic valve replacement; rheumatic fever; Ross procedure;
D O I
10.1177/2150135111425066
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Ross procedure is the aortic valve replacement of choice in children. Nonetheless late autograft reoperation for dilatation and/or regurgitation is concerning. We examine whether Ross procedure is suitable in children with rheumatic fever. Methods: Medical records of 104 children with rheumatic fever who underwent Ross procedure were reviewed (1991-2004). Competing risks methodology determined time-related prevalence and associated factors for two mutually exclusive end states: autograft reoperation and death prior to subsequent reoperation. Results: Mean age was 13.8 +/- 2.7 83 (80%) were males. Hemodynamic dysfunction was primarily regurgitation (n=92 88%) and stenosis/mixed (n=12 12%). Competing risks analysis showed that in ten years after the Ross procedure 1% of patients died 32% underwent autograft reoperation and 67% were alive and free from reoperation. Ten-year freedom from aortic regurgitation greater than or equal to moderate was 63%. Ten-year freedom from autograft reoperation was 65% for regurgitation versus 90% for stenosis/mixed disease. Risk factors for autograft reoperation were earlier surgery year (PE: 0.26 +/- 0.06 per year P<.001) additional surgery (PE: 0.82 +/- 0.39 P=.04) no annular stabilization (PE: 1.21 +/- 0.61 P =.05). Ten-year freedom from homograft replacement was 83%. Risk factors were fresh homografts (PE: 1.36 +/- 0.71 P =.06) and aortic homografts (PE: 1.15 +/- 0.59 P =.05). Ten-year freedom from any cardiac reoperation was 53%. Concomitant cardiac surgery was risk factor (PE: 1.37 +/- 0.47 P =.004). Conclusions: Ross procedure in children with rheumatic fever is associated with excellent survival but results are plagued by aortic regurgitation and frequent autograft reoperation. Risk factors include preoperative regurgitation concomitant surgery dilated annulus and earlier surgery era. Better patient selection in later era has mitigated autograft reoperation risk. Continued improved candidate selection along with modifications in autograft implantation and root/sinotubular stabilization techniques may further decrease late autograft failure.
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页码:8 / 15
页数:8
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