Безпосередні та віддалені результати модифікованої операції Росса

Abstract

The aim – to present our experience with a modified Ross procedure (RP) – total aortic root reinforcement (TARR) – which significantly reduces intraoperative risks and improves long-term outcomes.Materials and methods. The immediate and long-term results of 312 RPs performed between 2005 and 2023 were analyzed and compared, including 202 surgeries using the TARR technique and 110 with the standard technique. Statistical methods included regression-correlation analysis, prognostic modeling with stepwise binary logistic regression, ROC analysis, t-tests, and the information value (IV) test.Results. Hospital mortality was 2.2 %, and overall mortality was 3.2 %. Survival rates were: 100 % at 1 year, 98.6 % at 10 years (97.2–100; 95 % confidence interval, CI), and 97.8 % at 20 years (95.8–99.7; 95 % CI). Hospital and overall mortality were significantly lower in the TARR group compared to the standard method – 1 % versus 4.5 % (p = 0.007) and 1 % versus 7.3 % (p = 0.0013), respectively. Predictors of mortality included patient age (younger than 5.75 months), preoperative mechanical ventilation, Ross – Konno procedure, and use of the standard RP. The follow-up period averaged 79.8 ± 52 months (3-208 months) and was completed for 288 (95.3 %) patients. The systolic gradient on the autograft in the early postoperative period significantly decreased from a preoperative value of 57.0 mm Hg [36; 72] (6; 177) to 7 mm Hg [4; 11] (3; 19) (p = 0.0023). In the long-term period, it was 8 mm Hg [5; 13] (2; 59). Neo-aortic insufficiency (neoAI) was observed in the long-term period as follows: grade 0-1 in 263 (91.3 %) patients, grade 2 in 23 (8 %) patients, and grade 3 or higher in 2 (0.7 %) patients. Predictors of neoAI development included older age at surgery, use of the standard technique, and preoperative aortic insufficiency. There were 3 (1 %) reoperations on the autograft, with freedom from autograft reoperation rates of 100 %, 98.3 %, and 96.2 % at 5, 10, and 15 years post-surgery, respectively. The TARR technique reduced the risks of hospital and long-term mortality (p = 0.0027; OR 13.7 [7.56; 24.97]) as well as neo-aortic insufficiency and the need for reoperation (p = 0.002, odds ratio 4 [1.020; 19.506]).Conclusions. The modified Ross procedure effectively addresses aortic valve pathology in patients of various ages, ensuring high survival and quality of life. The TARR modification provides low surgical-stage risks, optimal hemodynamic properties of the pulmonary valve as an aortic valve prosthesis, the autograft’s capacity for growth while maintaining function, and minimal risks of autograft dysfunction.