Angell W W, Angell J D, Oury J H, Lamberti J J, Grehl T M
J Thorac Cardiovasc Surg. 1987 Jun;93(6):815-22.
There is currently a renewed interest in the use of both fresh and commercially available frozen homograft valves for children and young adults. This has prompted us to review a series of 32 patients who received frozen homograft valves for aortic replacement between 1973 and 1975. The cryogenic technique evolved to include the use of selected antibiotics and equilibrated dimethyl sulfoxide solution to freeze homografts at a rate of 1 degrees C per minute to liquid nitrogen temperatures of -196 degrees C. Histologic sections of experimental frozen valves explanted 6 months postoperatively revealed the presence of viable donor cells, and tissue culture demonstrated the reproductive capacity of cusp fibroblasts. Of the 32 frozen viable homografts implanted in this series, 23 were inserted as free-sewn aortic replacements and nine were premounted on stents before implantation in the aortic position. There were two operative deaths, and three valves failed as a result of the technical problems of mounting in one patient and surgical insertion of a free graft in two patients. Of the 22 patients who remained at long-term risk, 13% with free-sewn grafts and 57% with premounted valves underwent reoperation for valve failure. After 10 years of follow-up, 15 (68%) of these patients, 12 (80%) with free-sewn and three (43%) with premounted valves, are alive with their original valve in place. Actuarial analysis shows that 58% of the 32 valves implanted are functional at the beginning of the eleventh year. There have been six late deaths resulting in an overall actuarial patient survival rate of 79% at 10 years and 69% after 13 years. These clinical results are believed to add support to our current application of the frozen homograft in selected patients.
目前，对于儿童和年轻成人使用新鲜和市售冷冻同种异体瓣膜再度引起了人们的兴趣。这促使我们回顾了1973年至1975年间接受冷冻同种异体瓣膜进行主动脉置换的32例患者。低温保存技术不断发展，包括使用选定的抗生素和平衡的二甲基亚砜溶液，以每分钟1摄氏度的速率将同种异体移植物冷冻至液氮温度-196摄氏度。术后6个月取出的实验性冷冻瓣膜的组织学切片显示存在存活的供体细胞，组织培养证明瓣叶成纤维细胞具有繁殖能力。在该系列中植入的32个冷冻存活同种异体瓣膜中，23个作为游离缝合的主动脉置换物植入，9个在植入主动脉位置前预先安装在支架上。有2例手术死亡，3个瓣膜因1例患者安装的技术问题和2例患者游离移植物的手术植入问题而失败。在22例仍面临长期风险的患者中，13%的游离缝合移植物患者和57%的预先安装瓣膜患者因瓣膜功能衰竭接受了再次手术。经过10年的随访，这些患者中有15例（68%）存活，其中12例（80%）为游离缝合瓣膜，3例（43%）为预先安装瓣膜。精算分析表明，植入的32个瓣膜中有58%在第11年初仍具有功能。有6例晚期死亡，导致10年的精算患者总生存率为79%，13年后为69%。这些临床结果被认为支持了我们目前在选定患者中应用冷冻同种异体瓣膜的做法。
