Kloevekorn W P, Meisner H, Paek S U, Sebening F
Department of Cardiovascular Surgery, German Heart Center, Munich.
J Card Surg. 1991 Dec;6(4 Suppl):624-6. doi: 10.1111/jocs.1991.6.4s.624.
From 1975 to 1990, a total of 110 patients were operated for complex cardiac malformations with impaired pulmonary artery perfusion using porcine valved right heart to pulmonary artery conduits. Twelve- to 30-mm porcine valved conduits (Hancock or Carpentier-Edwards) were implanted at the age of 4 weeks to 28 years (mean 4.3 years). The patients' body weights were 2.9-68 kg (mean 15.3 kg). Early mortality was 5.5% (six patients), late mortality was 12.7% (14 patients), and 90 patients could be included in this long-term follow-up (426 patient-years). So far, 41 of the conduits had to be exchanged 4 months to 15 years (mean 6.5 years) after the first implantation. Forty-nine of the conduits are still in place. At reoperation, 38 patients received an allograft; three patients, reoperated before 1982, had a second xenograft. The main reason for porcine conduit malfunction was degeneration and/or calcification of the valves. In 11 patients, however, with 12- and 14-mm conduits implanted at a mean age of 3.1 years, a reoperation was necessary after a mean time of 6.8 years because these children had "outgrown" the conduit and needed a bigger one. We conclude that even though allografts seem to be the conduit of choice for right ventricular outflow tract reconstruction, our clinical experience shows that porcine valved conduits can be used just as well since most of them function sufficiently well for as long as 5 to 10 years, and early valve failure is relatively rare.
1975年至1990年期间，共有110例患者接受了使用猪带瓣右心至肺动脉管道以治疗肺动脉灌注受损的复杂心脏畸形手术。12至30毫米的猪带瓣管道（汉考克或卡彭蒂埃 - 爱德华兹）在4周龄至28岁（平均4.3岁）时植入。患者体重为2.9至68千克（平均15.3千克）。早期死亡率为5.5%（6例患者），晚期死亡率为12.7%（14例患者），90例患者可纳入此次长期随访（426患者年）。到目前为止，41根管道在首次植入后4个月至15年（平均6.5年）不得不进行更换。49根管道仍在位。再次手术时，38例患者接受了同种异体移植物；3例在1982年前再次手术的患者接受了第二次异种移植物。猪管道功能障碍的主要原因是瓣膜退变和/或钙化。然而，在11例平均年龄3.1岁时植入12毫米和14毫米管道的患者中，平均6.8年后需要再次手术，因为这些儿童“生长超过了”管道，需要更大的管道。我们得出结论，尽管同种异体移植物似乎是右心室流出道重建的首选管道，但我们的临床经验表明，猪带瓣管道也可以同样使用，因为它们中的大多数在长达5至10年的时间里功能足够良好，而且早期瓣膜故障相对罕见。
