Children Hospital of Illinois, OSF Saint Francis Medical Center, University of Illinois College of Medicine at Peoria, Peoria, IL 63603, USA.
J Thorac Cardiovasc Surg. 2012 Mar;143(3):543-9. doi: 10.1016/j.jtcvs.2011.12.032.
Standard cryopreserved valved allografts (SCAs) are recognized as the benchmark for reconstruction of the right ventricular outflow tract (RVOT). However, SCAs frequently demonstrate early valve deterioration and elicit an immune response. Decellularized cryopreserved valve allografts (SynerGraft, SG) are less immunogenetic and may be more durable. This study analyzed our results of RVOT reconstruction using SGs and compared it with the SCAs used during the same period.
We reviewed the outcome of all allografts (SG and SCA) that were implanted for RVOT reconstruction at a single center from 2000 to 2005. Echocardiographic data were reviewed to evaluate valve performance. Conduit failure is defined as the need for conduit replacement or reintervention in either the catheterization laboratory or operating room. Conduit dysfunction is defined as RVOT obstruction with peak echocardiographic Doppler gradient greater than 40 mm Hg and/or grade III/IV or greater conduit valve regurgitation. Data were compared using the Wilcoxon rank sum and Fisher's exact test.
From January 2000 to April 2005, 100 patients (mean age 18.6 ± 16.8 years) received SG (n = 39) or SCA (n = 61) conduits. The 2 retrospective nonrandomized cohorts were similar with respect to age, gender, weight, conduit indication, bypass and crossclamp time, and conduit size. Follow-up time was not significant between the 2 groups (SG, 5.7 ± 2.5 years vs SCA, 5.8 ± 2.8 years; P = .83). Early and late mortality were similar (SG, 13%; SCA, 10%; P = .75). No death was graft related. Freedom from dysfunction was superior with SG (SG, 74%, vs SCA, 52%; P = .05). Freedom from failure was also better in patients with SG (SG, 87%, vs SCA, 68%; P = .05). Freedom from explantation and more than moderate pulmonary insufficiency were significantly better for SG patients (SG, 92% and 90%, vs SCA, 78% and 68%; P = .02).
This study suggests that the midterm performance of SGs may be superior to that of SCAs. Decellularization of the cryopreserved allografts may provide a more durable option for patients who need RVOT reconstruction. Further long-term follow-up is needed to see whether this decellularization process improves long-term allograft durability.
标准冷冻保存同种异体移植物（SCAs）被认为是重建右心室流出道（RVOT）的基准。然而，SCAs 经常表现出早期瓣膜恶化，并引发免疫反应。去细胞冷冻保存同种异体移植物（SynerGraft，SG）的免疫原性较低，可能更耐用。本研究分析了我们在单个中心使用 SG 进行 RVOT 重建的结果，并将其与同期使用的 SCA 进行了比较。
我们回顾了 2000 年至 2005 年在单个中心植入用于 RVOT 重建的所有同种异体移植物（SG 和 SCA）的结果。回顾超声心动图数据以评估瓣膜性能。移植物失败定义为需要在导管实验室或手术室更换或再次介入移植物。移植物功能障碍定义为 RVOT 梗阻，峰值超声心动图多普勒梯度大于 40mmHg，或 III/IV 级或更高级别的移植物瓣反流。使用 Wilcoxon 秩和检验和 Fisher 确切检验比较数据。
从 2000 年 1 月至 2005 年 4 月，100 例患者（平均年龄 18.6±16.8 岁）接受了 SG（n=39）或 SCA（n=61）移植物。这两个回顾性非随机队列在年龄、性别、体重、移植物适应证、旁路和交叉钳夹时间以及移植物大小方面相似。两组的随访时间无显著差异（SG，5.7±2.5 年 vs SCA，5.8±2.8 年；P=0.83）。早期和晚期死亡率相似（SG，13%；SCA，10%；P=0.75）。无死亡与移植物相关。SG 的功能障碍无明显不良（SG，74%，SCA，52%；P=0.05）。SG 患者的移植物失败也更好（SG，87%，SCA，68%；P=0.05）。SG 患者的移植物取出和中重度肺动脉瓣关闭不全明显优于 SCA 患者（SG，92%和 90%，SCA，78%和 68%；P=0.02）。
本研究表明，SG 的中期表现可能优于 SCA。冷冻保存同种异体移植物的去细胞化可能为需要 RVOT 重建的患者提供更耐用的选择。需要进一步的长期随访，以观察这种去细胞化过程是否能提高同种异体移植物的长期耐久性。
