Vogt Ferdinand, Kowert Anke, Beiras-Fernandez Andres, Oberhoffer Martin, Kaczmarek Ingo, Reichart Bruno, Kilian Eckehard
Department of Cardiac Surgery, University Hospital, Ludwig-Maximilians University, Marchioninistrasse 15, Munich, Germany.
Heart Surg Forum. 2011 Aug;14(4):E237-41. doi: 10.1532/HSF98.20101162.
The use of homografts for aortic valve replacement (AVR) is an alternative to mechanical or biological valve prostheses, especially in younger patients. This retrospective comparative study evaluated our single-center long-term results, with a focus on the different origins of the homografts.
Since 1992, 366 adult patients have undergone AVR with homografts at our center. We compared 320 homografts of aortic origin and 46 homografts of pulmonary origin. The grafts were implanted via either a subcoronary technique or the root replacement technique. We performed a multivariate analysis to identify independent factors that influence survival. Freedom from reintervention and survival rates were calculated as cumulative events according to the Kaplan-Meier method, and differences were tested with the log-rank test.
Overall mortality within 1 year was 6.5% (21/320) in the aortic graft group and 17.4% (8/46) in the pulmonary graft group. In the pulmonary graft group, 4 patients died from valve-related complications, 1 patient died after additional heterotopic heart transplantation, and 1 patient who entered with a primary higher risk died from a prosthesis infection. Two patients died from non-valve-related causes. During the long-term follow-up, the 15-year survival rate was 79.9% for patients in the aortic graft group and 68.7% for patients in the pulmonary graft group (P = .049). The rate of freedom from reoperation was 77.7% in the aortic graft group and 57.4% in the pulmonary graft group (P < .001). The reasons for homograft explantation were graft infections (aortic graft group, 5.0%; pulmonary graft group, 6.5%) and degeneration (aortic graft group, 7.5%; pulmonary graft group, 32.6%).
Our study demonstrated superior rates of survival and freedom from reintervention after AVR with aortic homografts. Implantation with a pulmonary graft was associated with a higher risk of redo surgery, owing to earlier degenerative alterations.
使用同种移植物进行主动脉瓣置换术（AVR）是机械或生物瓣膜假体的一种替代方案，尤其适用于年轻患者。这项回顾性比较研究评估了我们单中心的长期结果，重点关注同种移植物的不同来源。
自1992年以来，我们中心有366例成年患者接受了同种移植物主动脉瓣置换术。我们比较了320例主动脉来源的同种移植物和46例肺动脉来源的同种移植物。移植物通过冠状动脉下技术或根部置换技术植入。我们进行了多变量分析以确定影响生存的独立因素。根据Kaplan-Meier方法将免于再次干预和生存率计算为累积事件，并使用对数秩检验来检验差异。
主动脉移植物组1年内的总死亡率为6.5%（21/320），肺动脉移植物组为17.4%（8/46）。在肺动脉移植物组中，4例患者死于瓣膜相关并发症，1例患者在进行额外的异位心脏移植后死亡，1例初诊时风险较高的患者死于假体感染。2例患者死于非瓣膜相关原因。在长期随访中，主动脉移植物组患者的15年生存率为79.9%，肺动脉移植物组患者为68.7%（P = 0.049）。主动脉移植物组再次手术的免手术率为77.7%，肺动脉移植物组为57.4%（P < 0.001）。同种移植物取出的原因是移植物感染（主动脉移植物组为5.0%；肺动脉移植物组为6.5%）和退变（主动脉移植物组为7.5%；肺动脉移植物组为32.6%）。
我们的研究表明，主动脉同种移植物置换主动脉瓣后具有更高的生存率和免于再次干预率。由于早期退变改变，植入肺动脉移植物与再次手术的风险较高相关。
