Spadaccio Cristiano, Rainer Alberto, Barbato Raffaele, Trombetta Marcella, Chello Massimo, Meyns Bart
Department of Cardiac Surgery, University Hospital UZ Leuven, Belgium -
CIR-Laboratory of Tissue Engineering, Campus Bio-Medico University, Rome, Italy.
J Cardiovasc Surg (Torino). 2019 Aug;60(4):501-513. doi: 10.23736/S0021-9509.16.08061-7. Epub 2014 Apr 14.
Synthetic grafts have been widely used in cardiac and vascular surgery since the mid-1970s. Considering the relative lack of randomized clinical trials or systematic analyses in the field of prosthetic large vessel diameter replacement, we reviewed the literature on the long-term performance and surgical management of complications of Dacron® grafts in both thoracic and abdominal aorta reconstruction and in the pediatric population. MedLine, Embase and Cochrane Library databases were searched for meta-analyses, reviews, clinical trials, and case reports pertinent to the study object. Aortic replacement with Dacron® prostheses is widely performed with acceptable outcome and a relatively low rate of graft-related and postimplantation complications, such as rupture, infection and fistulization. However, progressive dilation and mechanical failure of the grafts represent the most worrisome complication in all the districts analyzed. The emerging concept of the mismatch in the biomechanical properties between the prosthetic material and native aorta is thought to be at the root of these complications leading to even more daunting consequences when the ascending aorta is involved. Indeed introduction of a non-compliant prosthesis in place of the native ascending aorta can exert detrimental effects not only at the level of the anastomosis, leading to pseudoaneurysm, but also can influence the optimal performance of the aortic root complex with consequent valve dysfunction and ventricular hypertrophy. Albeit confirming their overall successful performance, this review launches a warning on the current liberal use of non-compliant grafts in aortic position, remarking the need for alternative vascular conduits mimicking the native artery compliance.
自20世纪70年代中期以来，合成移植物已广泛应用于心脏和血管外科手术。鉴于人工大血管直径置换领域相对缺乏随机临床试验或系统分析，我们回顾了有关涤纶（Dacron®）移植物在胸主动脉和腹主动脉重建以及儿科人群中的长期性能和并发症外科处理的文献。检索了MedLine、Embase和Cochrane图书馆数据库，以查找与研究对象相关的荟萃分析、综述、临床试验和病例报告。使用涤纶（Dacron®）假体进行主动脉置换术广泛开展，其结果可接受，与移植物相关的并发症和植入后并发症（如破裂、感染和瘘管形成）发生率相对较低。然而，在所有分析的部位，移植物的渐进性扩张和机械故障是最令人担忧的并发症。人工材料与天然主动脉之间生物力学性能不匹配这一新兴概念被认为是这些并发症的根源，当升主动脉受累时会导致更可怕的后果。事实上，用顺应性差的假体替代天然升主动脉不仅会在吻合口水平产生有害影响，导致假性动脉瘤，还会影响主动脉根部复合体的最佳性能，进而导致瓣膜功能障碍和心室肥厚。尽管证实了它们总体上的成功性能，但本综述对目前在主动脉位置随意使用顺应性差的移植物发出了警告，指出需要替代血管管道来模拟天然动脉的顺应性。
