罗斯手术后的再手术:一项回顾性研究

I. Chernov, S. Enginoev, A. A. Zenkov, U. K. Abdulmejidova, M. A. Guliyev
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引用次数: 0

摘要

目的分析罗斯手术后再次介入治疗的即时效果。2009年4月至2022年12月,联邦心血管外科中心共为224名成人实施了罗斯手术。这项回顾性研究包括17名需要重复干预的患者(14名男性/3名女性)。患者的平均年龄为38±11岁,最小21岁,最大54岁。4名患者(23.5%)有感染性心内膜炎病史,3名患者(17.6%)有高血压病史。在17名患者中,15名患者接受了经典的罗斯手术("全根置换"),2名患者接受了改良技术(1名患者用主动脉包裹,1名患者用达克龙移植物包裹)。3名患者先前进行了瓣环增强手术。对肺自体移植和同种移植进行干预的病例分别为 16 例和 4 例。肺自动脉移植介入治疗的主要适应症是主动脉瓣反流(15 例)和新主动脉瘤(14 例)。3例患者出现肺自动脉移植狭窄,1例出现血栓形成。两名患者需要对其他瓣膜进行干预:1 名患者为二尖瓣狭窄,1 名患者为严重的三尖瓣反流。平均再手术时间、心肺旁路时间和心肌缺血时间分别为(289±62)分钟、(126±35)分钟和(98±22)分钟。6例患者接受了联合介入治疗。9例患者进行了大卫瓣膜保留术,3例患者进行了Bentall-de Bono技术,2例患者进行了主动脉瓣修复术,2例患者进行了主动脉瓣机械置换术,2例患者进行了冠状动脉上主动脉置换术,2例患者进行了肺动脉同种异体移植置换术,1例患者进行了肺动脉同种异体移植血栓切除术,1例患者进行了肺动脉同种异体移植修复术,1例患者进行了二尖瓣置换术,1例患者进行了三尖瓣修复术。一名患者因出血需要进行再疝切除术。术后无并发症(围术期心肌梗死、急性肾损伤、中风、胸骨感染、心脏填塞)和死亡。重症监护室的中位住院时间为21 [16-23]小时。罗斯手术后可能因不同病理情况而需要再次手术,但所有手术均可由经验丰富的操作者实施,安全性较高。
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Reoperations after Ross procedure: a retrospective study
Aim. To analyze the immediate outcomes of reinterventions after Ross procedure.Material and methods. From April 2009 to December 2022, 224 Ross operations in adults were performed at the Federal Center for Cardiovascular Surgery. The retrospective study included 17 patients who required repeated interventions (14 men/3 women). The mean age of the patients was 38±11 years, with a minimum age of 21 and a maximum of 54 years. A history of infective endocarditis was revealed in 4 (23,5%) patients, hypertension — in 3 (17,6%) patients. Of the 17 included patients, 15 patients underwent the classic Ross operation ("full root replacement"), while 2 — a modified technique (1 — wrapping with aorta, 1 — wrapping with a Dacron graft). Annulus enhancement was previously performed in 3 patients.Results. Interventions on the pulmonary autograft and homograft were performed in 16 and 4 cases, respectively. The main indication for pulmonary autograft intervention was aortic regurgitation in 15 cases, and neoaortic aneurysm in 14 cases. In 3 patients, there was pulmonary homograft stenosis, while in 1 case — thrombosis. Two patients required interventions on other valves: 1 — mitral valve stenosis, 1 — severe tricuspid regurgitation. Mean reoperation, cardiopulmonary bypass and myocardial ischemia time were 289±62, 126±35 and 98±22 min, respectively. Combined interventions were performed in 6 cases. David valve-sparing procedure was performed in 9 patients, Bentall-de Bono technique — in 3, aortic valve repair — in 2, mechanical aortic valve replacement — in 2, supracoronary ascending aorta replacement — in 2, pulmonary homograft replacement — in 2, pulmonary homograft thrombectomy — in 1, pulmonary homograft repair — in 1 patient, mitral valve replacement — in 1 patient, tricuspid valve repair — in 1 patient. One patient required resternotomy for bleeding. There were no postoperative complications (perioperative myocardial infarction, acute kidney injury, stroke, sternal infection, cardiac tamponade) and deaths. The median length of stay in intensive care unit was 21 [16-23] hours.Conclusion. Reoperations after the Ross procedure may be required for different pathologies, but all can be performed surgically with a high safety in experienced operator.
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来源期刊
Russian Journal of Cardiology
Russian Journal of Cardiology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
2.20
自引率
0.00%
发文量
185
审稿时长
1 months
期刊介绍: Russian Journal of Cardiology has been issued since 1996. The language of this publication is Russian, with tables of contents and abstracts of all articles presented in English as well. Editor-in-Chief: Prof. Eugene V.Shlyakhto, President of the Russian Society of Cardiology. The aim of the journal is both scientific and practical, also with referring to organizing matters of the Society. The best of all cardiologic research in Russia is submitted to the Journal. Moreover, it contains useful tips and clinical examples for practicing cardiologists. Journal is peer-reviewed, with multi-stage editing. The editorial board is presented by the leading cardiologists from different cities of Russia.
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