Nappi Francesco, Al-Attar Nawwar, Spadaccio Cristiano, Chello Massimo, Lusini Mario, Acar Christophe
Centre Cardiologique du Nord St. Denis, France.
olden Jubilee National Hospital Clydebank, The United Kingdom.
Surg Technol Int. 2014 Mar;24:265-72.
The first aortic valve homograft was implanted by Sir Donald Ross in 1962. Since then, over 25,000 aortic homografts have been implanted worldwide. Unfortunately, the current cryopreservation method promotes a degenerative process leading to progressive homograft fibrosis and calcification. Valve durability of fresh allografts appears to be superior to cryopreserved grafts. The main indications of aortic valve replacement with a homograft are endocarditis, rheumatic disease, bicuspid and dystrophic aortopathies. Our experience with 210 aortic homografts implanted over a 10-year period is reported. We describe the different implantation techniques with particular emphasis on the current technique of choice, namely homograft root replacement. Approximately one-fourth of all aortic homografts will experience structural valve deterioration at 12 years. Structural homograft valve deterioration translates predominately into valve insufficiency and less frequently into stenosis. Young recipient age it appears is the major determinant of reoperation. Predictors of early and late mortality are discussed.
1962年，唐纳德·罗斯爵士植入了首个主动脉瓣同种异体移植瓣膜。从那时起，全球已植入超过25000个主动脉同种异体移植瓣膜。不幸的是，目前的冷冻保存方法会引发一种退行性过程，导致同种异体移植瓣膜逐渐纤维化和钙化。新鲜同种异体移植瓣膜的耐久性似乎优于冷冻保存的瓣膜。同种异体移植瓣膜置换主动脉瓣的主要适应症为心内膜炎、风湿性疾病、二叶式主动脉瓣及营养不良性主动脉病变。本文报告了我们在10年期间植入210个主动脉同种异体移植瓣膜的经验。我们描述了不同的植入技术，并特别强调了当前的首选技术，即同种异体移植瓣膜根部置换术。在12年时，所有主动脉同种异体移植瓣膜中约有四分之一会出现结构性瓣膜退变。结构性同种异体移植瓣膜退变主要表现为瓣膜关闭不全，较少表现为狭窄。年轻的受者年龄似乎是再次手术的主要决定因素。本文还讨论了早期和晚期死亡率的预测因素。
