Al Halees Zohair, Al Shahid Maie, Al Sanei Aly, Sallehuddin Ahmed, Duran Carlos
King Faisal Heart Institute at King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, MBC-16, Riyadh 11211, Saudi Arabia.
Eur J Cardiothorac Surg. 2005 Aug;28(2):200-5; discussion 205. doi: 10.1016/j.ejcts.2005.04.041.
There is lack of information regarding the long-term behavior of aortic valve reconstruction with pericardium (AoR). A 16-year follow-up is reported here.
Between 1988 and 1995, 92 consecutive patients had AoR with bovine (Group I, n=27) or glutaraldehyde-treated autologous pericardium (Group II, n=65). The mean age was 30 years (range 12-68). There were 65% males, 92% in sinus rhythm, 84% had rheumatic etiology and 36% had 'other valve' surgery. Mitral valve replacement with a mechanical prosthesis is a contraindication to the operation.
Hospital mortality was 2%. The reconstructed aortic valve performed well with excellent hemodynamics. The mean follow-up interval was 10.5+/-4 years, range 9-16 years (longer for group I,12 versus 10 years) with 4% late deaths and seven patients lost to follow-up. Survival rate was 85+/-4%. There were no episodes of thromboembolism. Freedom from reoperation for the whole group was 68+/-5% at 10 years and 47+/-6% at 16 years. For group I, it was 68+/-9% at 10 years and 48+/-10% at 16 years, while for group II it was 72+/-6 and 45+/-8% at 10 and 15 years, respectively. Excluding endocarditis (one in group I and seven in group II) and 'other' reasons for reoperation (two in group I and three in group II), the freedom from structural valve degeneration (SVD) at 10 and 16 years was 78+/-1 and 55+/-10% for group I. For group II, it was 80+/-5% at 10 years and 58+/-9% at 15 years. The mean interval at which the valve degenerated was 8.8 years+/-3.6 and did not differ between the two groups.
AoR is feasible with good hemodynamics, low mortality and thromboembolic rate. Its behavior at 10 years is comparable to that of stentless aortic valve bioprosthesis. It can be performed with either xenopericardium or glutaraldehyde-treated autologous pericardium, but the latter has the advantage of being inexpensive and readily available.
关于心包主动脉瓣重建术（AoR）的长期表现，目前缺乏相关信息。本文报告了一项长达16年的随访研究。
1988年至1995年间，92例连续患者接受了用牛心包（I组，n = 27）或经戊二醛处理的自体心包（II组，n = 65）进行的AoR手术。平均年龄为30岁（范围12 - 68岁）。男性占65%，窦性心律者占92%，风湿性病因者占84%，36%曾接受过“其他瓣膜”手术。使用机械瓣膜置换二尖瓣是该手术的禁忌证。
医院死亡率为2%。重建的主动脉瓣功能良好，血流动力学极佳。平均随访间隔为10.5±4年，范围9 - 16年（I组更长，为12年，II组为10年），4%患者晚期死亡，7例患者失访。生存率为85±4%。无血栓栓塞事件发生。全组10年免于再次手术率为68±5%，16年为47±6%。I组10年为68±9%，16年为48±10%；II组10年和15年分别为72±6%和45±8%。排除心内膜炎（I组1例，II组7例）和再次手术的“其他”原因（I组2例，II组3例），I组10年和16年免于结构性瓣膜退变（SVD）的比例分别为78±1%和55±10%。II组10年为80±5%，15年为58±9%。瓣膜发生退变的平均间隔时间为8.8年±3.6年，两组之间无差异。
AoR手术可行，血流动力学良好，死亡率和血栓栓塞率低。其10年表现与无支架主动脉瓣生物假体相当。该手术可用异种心包或经戊二醛处理的自体心包进行，但后者具有价格低廉且易于获取的优势。
