Talwar Sachin, Mohapatra Raghunath, Saxena Anita, Singh Rajvir, Kumar Arkalgud Sampath
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Ann Thorac Surg. 2005 Sep;80(3):832-8. doi: 10.1016/j.athoracsur.2005.03.056.
The aim of our study is to assess the results of aortic valve replacement with the aortic homograft.
From January 1994 through September 2003, 154 patients with aortic valve disease (rheumatic = 118, nonrheumatic = 36), and a mean age of 28.8 +/- 18.2 years, underwent aortic valve replacement with an aortic homograft by the scalloped subcoronary (n = 110) or root replacement (n = 38) technique, or as a valved homograft conduit (n = 6). Associated procedures included mitral valve repair (n=30), open mitral commissurotomy (n = 22), tricuspid valve repair (n = 8), coronary artery bypass grafting (n = 6), and atrial septal defect closure (n = 1).
Early mortality was 7.8% (12 patients). Mean follow-up was 62 +/- 33.4 months (4 to 127 months; median, 68.5 months). One hundred and twenty-four survivors (87.3%) had no or trivial to mild aortic regurgitation. A total of six patients required reoperation for homograft dysfunction alone (n = 4), infective endocarditis (n = 1), or failure of mitral valve repair (n = 1). There were four late deaths. Actuarial and reoperation-free survival at the median follow-up were 92.2 +/- 2.2% and 95.8 +/- 1.9%, respectively. Freedom from significant aortic stenosis or regurgitation was 86.1 +/- 3.2%.
Aortic valve replacement with an aortic homograft can be performed with acceptable early and late mortality and provides satisfactory midterm results. We did not note any difference in homograft dysfunction and reoperation with the use of either scalloped subcoronary or root replacement technique.
我们研究的目的是评估主动脉同种异体移植瓣膜置换术的结果。
从1994年1月至2003年9月，154例主动脉瓣疾病患者（风湿性 = 118例，非风湿性 = 36例），平均年龄28.8±18.2岁，接受了主动脉同种异体移植瓣膜置换术，采用带槽冠状动脉下（n = 110）或根部置换（n = 38）技术，或作为带瓣同种异体移植管道（n = 6）。相关手术包括二尖瓣修复（n = 30）、直视二尖瓣交界切开术（n = 22）、三尖瓣修复（n = 8）、冠状动脉旁路移植术（n = 6）和房间隔缺损修补术（n = 1）。
早期死亡率为7.8%（12例患者）。平均随访时间为62±33.4个月（4至127个月；中位数为68.5个月）。124例幸存者（87.3%）无主动脉瓣反流或仅有轻微至轻度主动脉瓣反流。共有6例患者仅因同种异体移植瓣膜功能障碍（n = 4）、感染性心内膜炎（n = 1）或二尖瓣修复失败（n = 1）而需要再次手术。有4例晚期死亡。在中位随访时，精算生存率和无再次手术生存率分别为92.2±2.2%和95.8±1.9%。无严重主动脉瓣狭窄或反流的比例为86.1±3.2%。
主动脉同种异体移植瓣膜置换术可获得可接受的早期和晚期死亡率，并提供令人满意的中期结果。我们未发现采用带槽冠状动脉下或根部置换技术在同种异体移植瓣膜功能障碍和再次手术方面存在差异。
