Bebekler ve çocuklarda doğuştan aort kapak hastalıklarında Ross ve Ross-Konno ameliyatları

Amaç: Bu çalışmada doğuştan aort darlığı olan çocuk hastalarda Ross ve Ross-Konno ameliyatının erken ve orta dönem sonuçları bildirildi. Çalışma planı: Ocak 2011 - Aralık 2015 tarihleri arasında doğuştan aort darlığı ön tanısı ile Ross veya Ross-Konno ameliyatı yapılan toplam sekiz hasta (4 erkek, 4 kız; medyan yaş 4.5 yıl; dağılım, 3-17 yıl) retrospektif olarak incelendi. Kardiyopulmoner baypas ve kros-klemp süresi ve yoğun bakım ünitesi ve hastanede yatış süresi kaydedildi. Bulgular: Yedi hastaya daha önce girişim uygulanmıştı [balon valvuloplasti (n=4), ventriküler septal defekt tamiri (n=1), aort kapak tamiri (n=1) ve aort koarktasyon tamiri (n=1)]. Beş hastaya Ross-Konno ameliyatı yapılırken, geri kalan üç hastaya Ross ameliyatı yapıldı. İki hastada ilave subaortik rezeksiyon ve bir hastada mitral kapak tamiri gerekli oldu. Erişkin boyutundaki hastaya Dacron kondüit ile pulmoner otogreft wrapping yapıldı. Mortalite ve majör morbiditeye rastlanmadı. Ortalama kardiyopulmoner baypas ve kross klemp süresi sırasıyla 234±6 ve 177±4 dk idi. İki hastanın sternumu sonradan kapatıldı. Medyan yoğun bakım ünitesi ve hastane kalış süreleri sırasıyla 4.5 ve 13.5 gün idi. Ortalama takip süresi, 29.3±15.6 ay (dağılım, 3 ay - 4 yıl) idi. Yalnızca iki hastada hafif ila orta düzeyde pulmoner kondüit darlığı vardı. Son takip vizitinde hiçbir hastada orta veya ciddi aort kapak yetmezliği görülmedi. Sonuç: Çalışma bulgularımız, pulmoner otogreft ve pulmoner kondüit fonksiyonlarının orta dönem takipte çok iyi olduğunu göstermektedir. Bu bulgulara dayanarak, bebeklerde ve çocuklarda aort kapak replasmanı için Ross ve Ross-Konno ameliyatları, düşük mortalite oranları ile iyi birer seçenektir.

The Ross and Ross-Konno operations for congenital aortic valve diseases in infants and children

Background: In this study, we present early and mid-term outcomes of Ross and Ross-Konno operation in pediatric patients with congenital aortic stenosis.Methods: Between January 2011 and December 2015, a total of eight patients (4 boys, and 4 girls; median age 4.5 years; range 3 to 17 years) with a preliminary diagnosis of congenital aortic stenosis underwent either Ross or Ross-Konno operation were retrospectively analyzed. Duration of cardiopulmonary bypass and cross-clamp, and length of intensive care unit and hospital stays were recorded.Results: Seven patients had previous interventions [balloon valvuloplasty (n=4), ventricular septal defect repair (n=1), aortic valve repair (n=1), and aortic coarctation repair (n=1)]. The Ross-Konno operation was performed in five patients, while the remaining three patients underwent the Ross operation. Additional subaortic resection was required in two patients and mitral valve repair in one patient. Only one adult-sized patient had pulmonary autograft wrapping with Dacron conduit. There was no mortality and major morbidity. The mean cardiopulmonary bypass and cross-clamp times were 234±6 and 177±4 min, respectively. Two patients underwent delayed sternal closure. The median length of intensive care unit and hospital stays was 4.5 and 13.5 days, respectively. The mean follow-up was 29.3±15.6 months (range, 3 months to 4 years). Only two patients had mild-to-moderate pulmonary conduit stenosis. There was no moderate or severe aortic valve regurgitation in the final follow-up visit.Conclusion: Our study results show very good pulmonary autograft and pulmonary conduit functions in the mid-term follow-up. Based on these findings, the Ross and Ross-Konno operations remain a good option for aortic valve replacement in infants and children with low mortality rates.

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