Sadowski Jerzy, Kapelak Boguslaw, Bartus Krzysztof, Podolec Piotr, Rudzinski Pawel, Myrdko Tomasz, Wierzbicki Karol, Dziatkowiak Antoni
Department of Cardiovascular Surgery and Transplantology, Collegium Medicum, Jagiellonian University, Pradnicka 80, 31-202, Krakow, Poland.
Eur J Cardiothorac Surg. 2003 Jun;23(6):996-1000; discussion 1000-1. doi: 10.1016/s1010-7940(03)00109-x.
Through a retrospective study on the use of fresh homografts in 655 aortic valve replacement patients over a period of 23 years, we aimed to assess the reasons for eventual reoperation and causes of valve dysfunction.
Between January 1980 and December 2002, 655 patients received fresh homografts. All homografts were antibiotic sterilized and stored at 4 degrees C. During this time, 139 patients (116 male and 23 female) with a mean age of 46.7 years (range 18-72) required reoperation.
The 30-day hospital overall mortality was 2.87%. The mean durability for all homografts was 12.4+/-4.54 years (1 month to 23 years). The cumulative rates for freedom from reoperation for any cause were 94.09+/-2% at 5 years and 87.9%+/-4% at 10 years, 76.6 at 15 years, 49.55 at 20 years. The major cause of valve dysfunction and indication for reoperation was degeneration in 111 patients (79.8%). Predominant aortic valve insufficiency in 87 patients (62.5%) and predominant stenosis in 24 patients (17.26%). Endocarditis occurred in 21 patients (15.1%). Early endocarditis was diagnosed in five patients (3.59%), late endocarditis in 16 patients (11.5%). Additional causes for reoperation included ascending aortic aneurysm, mitral valve insufficiency and congestive cardiomyopathy. Seventeen patients (12.2%) required concomitant procedures. Coronary artery bypass grafting was performed in six cases (4.3%), mitral valve replacement in five cases (3.59%), mitral valve annuloplasty in six (4.3%). The primary reoperative procedure was artificial/mechanical aortic valve implantation. In five cases, St. Jude Medical conduit grafts were implanted due to ascending aortic aneurysms. Homograft reimplantation was performed in four cases. One patient underwent mitral valve replacement and one patient received a heart transplant.
The results of the study suggest that reoperation in patients with aortic homografts is a low-risk procedure as compared to alternative therapies. Primary allograft aortic valve replacement can give acceptable results for up to 23 years. The major cause of valve dysfunction and indication for reoperation was degeneration. Cumulative rates for freedom from reoperation for any cause in age groups suggest careful selection and indications in homograft implantation in the younger patients. Young age is a risk factor for an early homograft structural deterioration (degeneration).
通过对655例接受主动脉瓣置换术患者在23年期间使用新鲜同种异体移植物的回顾性研究，我们旨在评估最终再次手术的原因及瓣膜功能障碍的原因。
1980年1月至2002年12月期间，655例患者接受了新鲜同种异体移植物。所有同种异体移植物均经抗生素消毒并储存在4℃。在此期间，139例患者（116例男性和23例女性）平均年龄46.7岁（范围18 - 72岁）需要再次手术。
30天医院总体死亡率为2.87%。所有同种异体移植物的平均耐用时间为12.4±4.54年（1个月至23年）。任何原因导致的再次手术-free的累积发生率在5年时为94.09±2%，10年时为87.9%±4%，15年时为76.6%，20年时为49.55%。瓣膜功能障碍和再次手术指征的主要原因是111例患者（79.8%）发生退变。87例患者（62.5%）以主动脉瓣关闭不全为主，24例患者（17.26%）以狭窄为主。21例患者（15.1%）发生心内膜炎。5例患者（3.59%）诊断为早期心内膜炎，16例患者（11.5%）诊断为晚期心内膜炎。再次手术的其他原因包括升主动脉瘤、二尖瓣关闭不全和充血性心肌病。17例患者（12.2%）需要同期手术。6例（4.3%）进行了冠状动脉旁路移植术，5例（3.59%）进行了二尖瓣置换术，6例（4.3%）进行了二尖瓣环成形术。初次再次手术操作是人工/机械主动脉瓣植入。5例因升主动脉瘤植入了圣犹达医疗导管移植物。4例进行了同种异体移植物再植入。1例患者进行了二尖瓣置换术，1例患者接受了心脏移植。结论：研究结果表明，与其他替代疗法相比，主动脉同种异体移植物患者的再次手术是一种低风险手术。初次同种异体主动脉瓣置换术在长达23年的时间内可获得可接受的结果。瓣膜功能障碍和再次手术指征的主要原因是退变。各年龄组任何原因导致的再次手术-free的累积发生率提示在年轻患者同种异体移植物植入时要仔细选择和掌握指征。年轻是同种异体移植物早期结构恶化（退变）的一个危险因素。
