Ross手术的临床应用现状

Current Clinical Application of Ross Procedure

R oss手术自1967年应用于临床以来,已被用于各种原因引起的主动脉瓣狭窄、左心室流出道梗阻和二尖瓣病变。R oss手术经历了诸如根部置换、圆筒形包埋技术、瓣环缩小技术、R oss-K onno手术和自体肺动脉瓣二尖瓣置换术(R oss-K abban i手术或R ossⅡ手术)。由于自体肺动脉瓣有不需抗凝、大小适宜、能存活、生长和长期耐久的特性,并具有良好的血流动力学表现和对细菌性心内膜炎有抵抗力的优点,尤其适用于妊娠期妇女、儿童和青少年。现就R oss手术的外科技术、手术指征、选择标准、外科处理主动脉瓣狭窄、左心室流出道梗阻和二尖瓣病变的临床应用进展和效果进行综述。

The use of pulmonary autograft was first reported in 1967 by Ross for the treatment of aortic valve disease in adults. Since that time, Ross procedure has been applied to a variety of forms of aortic stenosis and left ventricular outflow tract obstruction and mitral valve disease, Ross procedure has undergone several modifications, such as the root replacement method, inclusion cylinder technique, annular reduction, Konno root enlargement procedures and replacement of the mitral valve with a pulmonary autograft （Ross-Kabbani procedure or Ross Ⅱ procedure）. Advantages of Ross procedure in women of childbearing age, children and young adults include freedom from anticoagulation, appropriate sizing, cellular viability with growth potential proportional to somatic growth, acceptable long-term durability, excellent hemodynamic performance and decreased susceptibility to endocarditis. Surgical technical aspects, indications, selection criteria for the Ross procedure and its modifications, their applicability in the surgical management of aortic stenosis, left ventricular outflow tract obstruction and mitral valve disease and clinical outcome of Ross procedure are reviewed in this article.