Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Eur J Cardiothorac Surg. 2011 Sep;40(3):571-8. doi: 10.1016/j.ejcts.2010.10.023. Epub 2010 Dec 4.
Allograft conduits are used for reconstruction of the right ventricular outflow tract in congenital heart malformations (biventricular repair) and autograft procedures. A retrospective evaluation of allograft reconstruction of the right-ventricular-outflow-tract reconstruction was conducted and a cross-sectional quality of life study was performed.
Between August 1986 and March 2009, 509 allografts (435 pulmonary and 74 aortic) were implanted in 463 pediatric and adult patients (308 right-sided congenital heart malformations and 155 autograft procedures). Perioperative and follow-up data were collected and analyzed. Kaplan-Meier analyses were done for survival, valve-related re-operation, and valve-related events. Cox regression analysis was used for evaluation of potential risk factors. In addition, the Short Form-36 was presented to patients to assess the perceived quality of life. The results of the Short Form-36 were compared to age-adjusted Dutch population norms.
The mean age at allograft implantation was 19 years (1 week-66 years). Mean follow-up was 9 years (2 days-22 years). Forty-eight patients died during follow-up. Patient survival was 93% at 10 years and 88% at 15 years. A total of 63 re-operations were required for allograft dysfunction in 58 patients. Freedom from valve-related re-operation was 89% at 10 years and 81% at 15 years. Freedom from valve-related events was 86% at 10 years and 74% at 15 years. Younger patient age (p=0.007) and the use of an aortic allograft (p<0.001) were identified as independent risk factors for allograft re-operation. Patients between 14 and 40 years scored significantly lower on 'physical functioning' and 'general health' subscales than the general Dutch population, but scored better on the subscales 'emotional role functioning' and 'bodily pain'. Except for the subscale 'general health', on which patients within our study population scored lower, patients between 41 and 60 years had comparable average scores as the general Dutch population. The older patient group (61 years or older) had a better average score on the subscale 'bodily pain' and similar scores on other subscales with respect to the general Dutch population.
Right-ventricular-outflow-tract reconstruction with an allograft conduit can be performed with good patient survival, acceptable long-term allograft durability, and good perceived quality of life.
同种异体移植物被用于重建先天性心脏畸形（双心室修复）和自体移植物的右心室流出道。对同种异体重建右心室流出道的情况进行了回顾性评估，并进行了横断面生活质量研究。
1986 年 8 月至 2009 年 3 月期间，在 463 名儿科和成年患者（308 例右侧先天性心脏病和 155 例自体移植物手术）中植入了 509 个同种异体移植物（435 个肺动脉和 74 个主动脉）。收集并分析围手术期和随访数据。进行 Kaplan-Meier 分析以评估生存率、与瓣膜相关的再手术和与瓣膜相关的事件。使用 Cox 回归分析评估潜在的危险因素。此外，还向患者提供了简短形式 36 来评估感知生活质量。将简短形式 36 的结果与年龄调整后的荷兰人群正常值进行比较。
同种异体移植物植入时的平均年龄为 19 岁（1 周至 66 岁）。平均随访时间为 9 年（2 天至 22 年）。48 名患者在随访期间死亡。患者 10 年生存率为 93%，15 年生存率为 88%。58 例患者因同种异体移植物功能障碍共进行了 63 次再手术。10 年时无瓣膜相关再手术的生存率为 89%，15 年时为 81%。10 年时无瓣膜相关事件的生存率为 86%，15 年时为 74%。患者年龄较小（p=0.007）和使用主动脉同种异体移植物（p<0.001）是同种异体移植物再手术的独立危险因素。14 至 40 岁的患者在“身体机能”和“一般健康”子量表上的得分明显低于普通荷兰人群，但在“情感角色功能”和“躯体疼痛”子量表上的得分更高。除了研究人群中的患者在“一般健康”子量表上的得分较低外，41 至 60 岁的患者的平均得分与普通荷兰人群相当。年龄较大的患者组（61 岁或以上）在“躯体疼痛”子量表上的平均得分较好，而在其他子量表上的得分与普通荷兰人群相似。
同种异体移植物右心室流出道重建可获得良好的患者生存率、可接受的长期同种异体移植物耐久性和良好的感知生活质量。
