Barratt-Boyes B G, Roche A H, Subramanyan R, Pemberton J R, Whitlock R M
Circulation. 1987 Apr;75(4):768-77. doi: 10.1161/01.cir.75.4.768.
A series of 252 isolated aortic homograft valves in 248 patients have been followed for 9 to 16.5 years (mean 10.8). The valves were sterilized in antibiotic solution and stored in a nutrient medium at 4 degrees C and were nonvital. There were 15 in-hospital deaths (6%) and a mortality of 2.7% in patients undergoing an elective first operation. Actuarial survival with the study valve in situ was 57% at 10 years and 38% at 14 years. Only 8.4% of the patients died late from homograft valve failure, chiefly because of failure to refer patients with endocarditis for reoperation or because reoperation was refused in elderly, frail subjects. Incompetence was the sole cause of valve failure and was due either to valve wear or endocarditis. Significant incompetence required reoperation. On actuarial analysis, freedom from significant incompetence for the entire group was 95% at 5 years, 78% at 10 years, and 42% at 14 years. Factors increasing the risk of significant incompetence due to valve wear on multivariate analysis were increasing donor valve age (greater than or equal to 55 years), recipient age (less than 15 years), and an aortic root diameter over 30 mm. Analysis of the patient group that excluded each of these variables (low-risk group), which comprised 61% of the study population, indicated freedom from significant incompetence due to valve wear of 98% at 5 years, 94% at 9 years, and 56% at 13 years.
对248例患者的252个孤立主动脉同种异体移植瓣膜进行了为期9至16.5年（平均10.8年）的随访。瓣膜在抗生素溶液中灭菌，于4℃保存在营养培养基中，已无活性。有15例住院死亡（6%），择期首次手术患者的死亡率为2.7%。研究瓣膜原位的精算生存率在10年时为57%，在14年时为38%。仅8.4%的患者因同种异体移植瓣膜衰竭而晚期死亡，主要是因为未将心内膜炎患者转诊进行再次手术，或者老年体弱患者拒绝再次手术。瓣膜功能不全是瓣膜衰竭的唯一原因，其原因要么是瓣膜磨损，要么是心内膜炎。严重功能不全需要再次手术。经精算分析，整个组在5年时无严重功能不全的概率为95%，在10年时为78%，在14年时为42%。多变量分析中增加因瓣膜磨损导致严重功能不全风险的因素包括供体瓣膜年龄增加（大于或等于55岁）、受体年龄（小于15岁）以及主动脉根部直径超过30 mm。对排除这些变量中的每一个变量的患者组（低风险组）进行分析，该组占研究人群的61%，结果显示因瓣膜磨损导致严重功能不全的概率在5年时为98%，在9年时为94%，在13年时为56%。
