Herreros J M, Mastrobuoni S, Ubilla M, Rábago G, Lorente Ruiz M, Rifón J, Hernández M
Servicio de Cirugía Cardiovascular, Clínica Universitaria de Navarra, 31008, Pamplona, Spain.
An Sist Sanit Navar. 2006;29 Suppl 2:153-61.
The advances in the manipulation of human tissues, the development of cryobiology, paediatric cardiac surgery, the impossibility of obtaining an ideal prosthetic cardiac valve and the surgical treatment of cardiovascular infections have revived interest in the use of homografts. The donors of these homografts can be: a) Live donors: aortic and pulmonary valve of the recipient of a heart transplant; b) Multiorgan donors with a diagnosis of death according to neurological criteria, whose heart is rejected for heart transplant; c) Cadaver donors with asystolia of less than 8 hours. Homograft cardiac valves are the substitute of choice in aortic valve endocarditis, patients with counter-indications for anticoagulation, reconstruction of the outflow tract of the right ventricle, aortic valve replacement in children and young adults through the Ross operation, and an optional indication is the aortic valve and/or rising aorta replacement in patients over 60 years of age. Although there are not sufficiently broad series of homogratfs with arterial substitutes, with respect to the number of patients and time of evolution, the results suggest that this can benefit patients with vascular infection, immunodepressed patients or complex patients whose technique during the operation might require a homograft.
人体组织操作技术的进步、低温生物学的发展、小儿心脏外科手术、理想人工心脏瓣膜难以获得以及心血管感染的外科治疗，都重新激发了人们对同种异体移植物应用的兴趣。这些同种异体移植物的供体可以是：a）活体供体：心脏移植受者的主动脉瓣和肺动脉瓣；b）根据神经学标准诊断为死亡的多器官供体，其心脏因心脏移植被拒收；c）心脏停搏时间少于8小时的尸体供体。同种异体心脏瓣膜是主动脉瓣心内膜炎、有抗凝禁忌证患者、右心室流出道重建、通过罗斯手术进行儿童和年轻成人主动脉瓣置换的首选替代物，一个可选适应证是60岁以上患者的主动脉瓣和/或升主动脉置换。尽管关于动脉替代物的同种异体移植物系列研究还不够广泛，从患者数量和随访时间来看，结果表明这可能使血管感染患者、免疫抑制患者或手术技术可能需要同种异体移植物的复杂患者受益。
