Urso Stefano, Rega Filip, Gewillig Marc, Eyskens Benedicte, Heying Ruth, Daenen Willem, Meyns Bart
Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
J Heart Valve Dis. 2012 Jul;21(4):521-6.
Human homografts are frequently used to establish an anatomic continuity between the right ventricular outflow tract (RVOT) and the pulmonary artery. Their limited availability, especially in small sizes, has encouraged the use of alternative strategies, such as size-reduced bicuspid homografts. The study aim was to analyze the follow up of patients who had received a standard tricuspid or size-reduced bicuspid homograft in the RVOT position, and to investigate modifications of the patients' Z-scores over the years.
A consecutive series of 107 patients aged < or = 16 years, who underwent RVOT repair between 1989 and 2010 to treat tetralogy of Fallot (ToF), was retrospectively reviewed. Of these patients, 17 received a size-reduced bicuspid pulmonary homograft, while 90 received a standard tricuspid homograft. The mean follow up periods were 10.5 years (range: 0.02-21.4 years) for the whole study population, and 11.8 years and 3.4 years, respectively, for the tricuspid and size-reduced bicuspid homograft groups.
Freedom from mortality at 10 years was 95 +/- 3%. During the observation period, 27 patients (31%) in the tricuspid homograft group and two (125) in the size-reduced bicuspid group presented with graft failure. According to the multivariable analysis, the only independent predictor of graft failure was patient age (hazards ratio 0.86). The 17 patients who had received a size-reduced bicuspid homograft were then age-matched to an equal-sized population of tricuspid homograft patients. A comparative analysis of the time-weighted average of the Z-scores for these tricuspid and size-reduced bicuspid homograft subgroups during the follow up period failed to identify any statistical difference (p = 0.5).
In terms of Z-score evolution, size-reduced bicuspid homografts offer results which are comparable to those achieved with tricuspid homografts.
人同种异体移植物常用于在右心室流出道（RVOT）和肺动脉之间建立解剖连续性。其供应有限，尤其是小尺寸的移植物，这促使人们采用替代策略，如尺寸缩小的双叶同种异体移植物。本研究旨在分析接受RVOT位置标准三叶或尺寸缩小的双叶同种异体移植物患者的随访情况，并调查多年来患者Z值的变化。
回顾性分析1989年至2010年间连续107例年龄≤16岁、因法洛四联症（ToF）接受RVOT修复的患者。其中，17例接受尺寸缩小的双叶肺动脉同种异体移植物，90例接受标准三叶同种异体移植物。整个研究人群的平均随访时间为10.5年（范围：0.02 - 21.4年），三叶和尺寸缩小的双叶同种异体移植物组分别为11.8年和3.4年。
10年无死亡率为95±3%。在观察期内，三叶同种异体移植物组27例患者（31%）和尺寸缩小的双叶组2例（125）出现移植物失败。根据多变量分析，移植物失败的唯一独立预测因素是患者年龄（风险比0.86）。然后将接受尺寸缩小的双叶同种异体移植物的17例患者与同等数量的三叶同种异体移植物患者进行年龄匹配。对这些三叶和尺寸缩小的双叶同种异体移植物亚组随访期间Z值的时间加权平均值进行比较分析，未发现任何统计学差异（p = 0.5）。
就Z值演变而言，尺寸缩小的双叶同种异体移植物的结果与三叶同种异体移植物相当。
