Abstract：
OBJECTIVE: The potential risk of autograft dilatation and homograft stenosis after the Ross procedure mandates lifelong follow-up. This retrospective cohort study aimed to determine long-term outcome of the Ross procedure, investigating autograft and homograft failure patterns leading to reintervention.
METHODS: All adults who underwent the Ross procedure between 1991 and 2018 at the University Hospitals Leuven were included, with follow-up data collected retrospectively. Autograft implantation was performed using the full root replacement technique. The primary end-point was long-term survival. Secondary end-points were survival free from any reintervention, autograft or homograft reintervention-free survival, and evolution of autograft diameter, homograft gradient and aortic regurgitation grade over time.
RESULTS: A total of 173 adult patients (66% male) with a median age of 32 years (range 18-58 years) were included. External support at both the annulus and sinotubular junction was used in 38.7% (67/173). Median follow-up duration was 11.1 years (IQR, 6.4-15.9; 2065 patient-years) with 95% follow-up completeness. There was one (0.6%) perioperative death. Kaplan-Meier estimate for 15-year survival was 91.1% and Ross-related reintervention-free survival was 75.7% (autograft: 83.5%, homograft: 85%). Regression analyses demonstrated progressive neoaortic root dilatation (0.56 mm/year) and increase in homograft gradient (0.72 mmHg/year).
CONCLUSIONS: The Ross procedure has the potential to offer excellent long-term survival and reintervention-free survival. These long-term data further confirm that the Ross procedure is a suitable option in young adults with aortic valve disease which should be considered on an individual basis.
METHODS: All adults who underwent the Ross procedure between 1991 and 2018 at the University Hospitals Leuven were included, with follow-up data collected retrospectively. Autograft implantation was performed using the full root replacement technique. The primary end-point was long-term survival. Secondary end-points were survival free from any reintervention, autograft or homograft reintervention-free survival, and evolution of autograft diameter, homograft gradient and aortic regurgitation grade over time.
RESULTS: A total of 173 adult patients (66% male) with a median age of 32 years (range 18-58 years) were included. External support at both the annulus and sinotubular junction was used in 38.7% (67/173). Median follow-up duration was 11.1 years (IQR, 6.4-15.9; 2065 patient-years) with 95% follow-up completeness. There was one (0.6%) perioperative death. Kaplan-Meier estimate for 15-year survival was 91.1% and Ross-related reintervention-free survival was 75.7% (autograft: 83.5%, homograft: 85%). Regression analyses demonstrated progressive neoaortic root dilatation (0.56 mm/year) and increase in homograft gradient (0.72 mmHg/year).
CONCLUSIONS: The Ross procedure has the potential to offer excellent long-term survival and reintervention-free survival. These long-term data further confirm that the Ross procedure is a suitable option in young adults with aortic valve disease which should be considered on an individual basis.
摘要：
目的：Ross手术后自体移植扩张和同种异体移植狭窄的潜在风险要求终身随访。这项回顾性队列研究旨在确定Ross手术的长期结果，调查导致再干预的自体移植和同种移植失败模式。
方法：所有在1991-2018年间在鲁汶大学医院接受罗斯手术的成年人都包括在内，回顾性收集随访数据。使用全根置换技术进行自体移植植入。主要终点是长期生存。次要终点是无任何再干预的生存率，自体移植或同种移植无再干预生存，和自体移植物直径的演变，随着时间的推移，同种异体移植梯度和主动脉瓣反流等级。
结果：共纳入173例成年患者（66%为男性），中位年龄为32岁（范围18-58岁）。在环和窦管连接处的外部支持使用占38.7%(67/173)。中位随访时间为11.1年(IQR，6.4-15.9；2065患者年），随访完成度为95%。围手术期死亡1例（0.6%）。Kaplan-Meier估计的15年生存率为91.1％，与Ross相关的再干预无生存率为75.7％（自体移植：83.5％，同种异体移植：85%）。回归分析显示新主动脉根部进行性扩张（0.56mm/年）和同种移植梯度增加（0.72mmHg/年）。
结论：Ross程序有可能提供良好的长期生存和无再干预生存。这些长期数据进一步证实，Ross手术是患有主动脉瓣疾病的年轻人的合适选择，应在个人基础上考虑。
方法：所有在1991-2018年间在鲁汶大学医院接受罗斯手术的成年人都包括在内，回顾性收集随访数据。使用全根置换技术进行自体移植植入。主要终点是长期生存。次要终点是无任何再干预的生存率，自体移植或同种移植无再干预生存，和自体移植物直径的演变，随着时间的推移，同种异体移植梯度和主动脉瓣反流等级。
结果：共纳入173例成年患者（66%为男性），中位年龄为32岁（范围18-58岁）。在环和窦管连接处的外部支持使用占38.7%(67/173)。中位随访时间为11.1年(IQR，6.4-15.9；2065患者年），随访完成度为95%。围手术期死亡1例（0.6%）。Kaplan-Meier估计的15年生存率为91.1％，与Ross相关的再干预无生存率为75.7％（自体移植：83.5％，同种异体移植：85%）。回归分析显示新主动脉根部进行性扩张（0.56mm/年）和同种移植梯度增加（0.72mmHg/年）。
结论：Ross程序有可能提供良好的长期生存和无再干预生存。这些长期数据进一步证实，Ross手术是患有主动脉瓣疾病的年轻人的合适选择，应在个人基础上考虑。
