Cleuziou Julie, Vitanova Keti, Kasnar-Samprec Jelena, Hörer Jürgen, Lange Rüdiger, Schreiber Christian
Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
Eur J Cardiothorac Surg. 2016 May;49(5):1421-5. doi: 10.1093/ejcts/ezv418. Epub 2015 Nov 27.
Small-sized homografts are rare but may be required for the reconstruction of the right ventricular outflow tract (RVOT). Down-sizing adult-sized homografts can be an option to overcome the shortage of availability.
Since 1994, we have been down-sizing adult-sized homografts by excising one cusp. The aim of the study was to analyse the durability of down-sized homografts and compare it with small-sized homografts in a paediatric population. All patients below a body weight of 14 kg were included in the study. The end-point of the study was homograft failure.
A total of 152 patients met the inclusion criteria of the study, of which 82 patients (54%) received a down-sized homograft. The median age was 17.1 (0.3-64.8) months and the mean weight 8.4 ± 3.4 kg. Fifty-eight patients (38%) were under 1 year and 10 (6.5%) under 1 month of age at the time of homograft implantation. The mean homograft size of the whole study population was 14.7 ± 2.5 mm and the mean z-score was 1.6 ± 0.9. The median follow-up time was 10 (0.03-19.7) years. Early mortality after homograft implantation was 5% (n = 8), 4 of these patients had received a down-sized homograft. The study population comprised early survivors, that is, 144 patients. During follow-up, a total of 46 homografts failed, 23 in each group, after a mean time of 5.7 ± 4.2 years. Freedom from homograft failure was 94.6 ± 2.6, 87.2 ± 4 and 68.6 ± 6.6% for down-sized homografts and 95.2 ± 2.7, 78.7 ± 5.5 and 61 ± 7% for small-sized homografts at 1, 5 and 10 years, respectively (P = 0.3). Risk factors for homograft failure in the multivariable analysis were a homograft z-score of <1 and age below 1 year at the time of implantation (P = 0.02).
Down-sized homografts demonstrated a durability similar to that of small-sized homografts. Therefore, down-sizing adult-sized homografts by creating a bicuspid valve to fit into the corresponding RVOT in children with congenital heart defects is an excellent method to overcome the shortage of small-sized homografts.
小型同种异体移植物较为罕见，但右心室流出道（RVOT）重建可能需要使用。缩小成人尺寸的同种异体移植物可能是克服供应短缺的一种选择。
自1994年以来，我们一直通过切除一个瓣叶来缩小成人尺寸的同种异体移植物。本研究的目的是分析缩小尺寸的同种异体移植物的耐用性，并将其与儿科人群中的小型同种异体移植物进行比较。所有体重低于14 kg的患者均纳入本研究。研究的终点是同种异体移植物失败。
共有152例患者符合研究纳入标准，其中82例（54%）接受了缩小尺寸的同种异体移植物。中位年龄为17.1（0.3 - 64.8）个月，平均体重为8.4±3.4 kg。58例（38%）患者在同种异体移植物植入时年龄小于1岁，10例（6.5%）年龄小于1个月。整个研究人群的同种异体移植物平均尺寸为14.7±2.5 mm，平均z值为1.6±0.9。中位随访时间为10（0.03 - 19.7）年。同种异体移植物植入后的早期死亡率为5%（n = 8），其中4例患者接受了缩小尺寸的同种异体移植物。研究人群包括早期幸存者，即144例患者。在随访期间，共有46个同种异体移植物失败，每组各23个，平均时间为5.7±4.2年。缩小尺寸的同种异体移植物在1年、5年和10年时免于同种异体移植物失败的比例分别为94.6±2.6%、87.2±4%和68.6±6.6%，小型同种异体移植物分别为95.2±2.7%、78.7±5.5%和61±7%（P = 0.3）。多变量分析中同种异体移植物失败的危险因素是同种异体移植物z值<1以及植入时年龄小于1岁（P = 0.02）。
缩小尺寸的同种异体移植物显示出与小型同种异体移植物相似的耐用性。因此，通过制作双叶瓣以适配先天性心脏病患儿相应的RVOT来缩小成人尺寸的同种异体移植物，是克服小型同种异体移植物短缺的一种极佳方法。
