Fiore Andrew C, Rodefeld Mark, Turrentine Mark, Vijay Palaniswamy, Reynolds Tyler, Standeven John, Hill Kirstin, Bost Jamie, Carpenter Dustin, Tobin Courtney, Brown John W
Division of Cardiothoracic Surgery, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri 63104, USA.
Ann Thorac Surg. 2008 May;85(5):1712-8; discussion 1718. doi: 10.1016/j.athoracsur.2008.02.001.
We retrospectively reviewed the performance of the mosaic porcine, bovine pericardial, and homograft prostheses for pulmonary valve replacement to correct chronic pulmonary insufficiency.
From January 1995 to August 2006, 82 patients (mean age, 22.7 years) underwent valve replacement with porcine (49 patients), bovine pericardial (18 patients), or pulmonary homograft (15 patients) prosthesis at a mean of 15.3 years after initial outflow tract reconstruction. Excluded were patients with extracardiac conduits, monocusp valves, or the Ross procedure. The groups were similar with respect to age, body surface area, degree of regurgitation, right ventricular dimension, right ventricular to pulmonary artery gradient, and valve size. Follow-up was longer in the homograft cohort (porcine, 20 +/- 27 months; pericardial, 42 +/- 21; homograft, 49 +/- 40; p < 0.01).
All three prostheses significantly reduce chronic pulmonary regurgitation, but late insufficiency was higher with homografts. Right ventricular dimension was significantly reduced in the stented but not the allograft cohorts. Late valve dysfunction was highest with homografts (54%), followed by porcine (19%) and pericardial valves (5.5%; p < 0.05. Functional class and mild to moderate tricuspid insufficiency significantly improved with pulmonary valve replacement. Early and late mortality was 3.6% and 1.2%, respectively.
All three prostheses performed similarly for 3 years. Pulmonary regurgitation developed more frequently in homografts albeit at a longer duration of follow-up.
我们回顾性分析了镶嵌猪心包、牛心包和同种异体移植物人工瓣膜在肺动脉瓣置换术中纠正慢性肺动脉瓣关闭不全的性能。
1995年1月至2006年8月，82例患者（平均年龄22.7岁）在初次流出道重建术后平均15.3年接受了瓣膜置换术，其中49例使用猪心包人工瓣膜，18例使用牛心包人工瓣膜，15例使用同种异体肺动脉移植物。排除有心外管道、单叶瓣膜或Ross手术的患者。三组患者在年龄、体表面积、反流程度、右心室大小、右心室至肺动脉压差和瓣膜尺寸方面相似。同种异体移植物队列的随访时间更长（猪心包组，20±27个月；心包组，42±21个月；同种异体移植物组，49±40个月；p<0.01）。
所有三种人工瓣膜均显著减少慢性肺动脉反流，但同种异体移植物的晚期关闭不全发生率更高。带支架人工瓣膜组的右心室大小显著减小，而异体移植组则未减小。同种异体移植物的晚期瓣膜功能障碍发生率最高（54%），其次是猪心包人工瓣膜（19%）和心包人工瓣膜（5.5%；p<0.05）。肺动脉瓣置换术后功能分级及轻至中度三尖瓣关闭不全均有显著改善。早期和晚期死亡率分别为3.6%和1.2%。
三种人工瓣膜在3年内的表现相似。尽管随访时间较长，但同种异体移植物中肺动脉反流的发生更为频繁。
