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Die Ross-Operation bei Kindern

Ergebnisse aus dem Europäischen Ross-Register

The Ross operation in children

Results from the European Ross Registry

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Hintergrund

Ziel dieser Arbeit ist, es die Haltbarkeit von Auto- und Homograft nach einer Ross-Operation bei Kindern zu untersuchen.

Patienten und Methoden

Die Daten von 152 Kindern, die zum Zeitpunkt der Ross-Operation jünger als 16 Jahre waren, wurden mittels Cox-Regression und hierarchischer Multilevelanalyse ausgewertet.

Ergebnisse

Die mittleren z-Werte des sinutubulären Übergangs des Autograft und die Autograftinsuffizienz nahmen mit der Zeit zu (0,7±0,2 z-Werte/Jahr; p<0,001 und 0,07±0,02 Grade/Jahr; p<0,001). Die Autograftinsuffizienz steigerte sich mit zunehmendem Durchmesser des sinutubulären Übergangs (p=0,028). Der mittlere Gradient über den Homograft nahm in den ersten 2 Jahren jährlich um 4,2 mmHg zu (p<0,001). Die Freiheit von Reoperationen des Autograft betrug nach 10 Jahren 95,2±2,7%, die des Homograft 79,6±6,1%. Eine längere Nachuntersuchungszeit war ein Risikofaktor für Reoperationen des Autograft (p=0,036), die Implantation eines Aortenhomograft ein Risikofaktor für Reoperationen des Homograft (p=0,013).

Schlussfolgerung

Autograftinsuffizienz und Homograftstenosen sind die Probleme nach einer Ross-Operation bei Kindern. Ursache der Autograftinsuffizienz ist eine Dilatation des sinutubulären Übergangs. Die Entwicklung des Gradienten über den Homograft ist verglichen mit Aortenhomografts bei Pulmonalishomografts geringer.

Abstract

Objectives

To determine the durability of autografts and homografts after Ross operations in children.

Patients and methods

The data of 152 children <16 years were analyzed using the Cox proportional hazards model and hierarchical multilevel modeling.

Results

Autograft regurgitation increased with sinotubular junction diameter (p=0.028). The homograft gradient increased within the first 2 years (4.2 mmHg/year, p<0.001). Freedom from autograft and homograft reintervention at 10 years was 95.5±2.7% and 79.6±6.1%, respectively. Longer follow-up time was a risk factor for autograft reintervention (p=0.036). Use of an aortic homograft was a risk factor for conduit reintervention (p=0.013).

Conclusions

Reinterventions are necessary for autograft regurgitation and homograft stenosis. Increasing sinotubular junction diameters explain autograft regurgitation. Using pulmonary homografts delays the development of a homograft gradient.

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Danksagung

Die Autoren bedanken sich bei Herrn Derek R. Robinson, MA MSc DPhil CStat, Department of Mathematics, School of Science and Technology, University of Sussex, Brighton, United Kingdom, für die statistische Auswertung der seriellen echokardiographischen Daten und bei Frau Katrin Meyer für ihr hervorragendes Datenmanagement und ihre Unterstützung im Studiensekretariat der Registerstelle an der Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck.

Interessenkonflikt

Der Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland

    J. Hörer MD, PhD & R. Lange

  2. Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    U. Stierle, T. Hanke & H.H. Sievers

  3. Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Rotterdam, Niederlande

    J.J. Takkenberg & A.J.J.C. Bogers

  4. Sana Herzchirurgische Klinik Stuttgart, Stuttgart, Deutschland

    W. Hemmer & J.G. Rein

  5. German Heart Center Berlin, Berlin, Deutschland

    M. Hübler & R. Hetzer

Authors
  1. J. Hörer MD, PhD
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  2. U. Stierle
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  3. T. Hanke
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  4. J.J. Takkenberg
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  5. A.J.J.C. Bogers
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  6. W. Hemmer
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  7. J.G. Rein
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  8. M. Hübler
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  9. R. Hetzer
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  10. H.H. Sievers
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  11. R. Lange
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Corresponding author

Correspondence to J. Hörer MD, PhD.

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Hörer, J., Stierle, U., Hanke, T. et al. Die Ross-Operation bei Kindern. Z Herz- Thorax- Gefäßchir 24, 115–121 (2010). https://doi.org/10.1007/s00398-010-0768-z

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  • DOI: https://doi.org/10.1007/s00398-010-0768-z

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