O'Brien M F, Clarebrough J K, McDonald I G, Hale G S, Bray H S, Cade J F
Thorax. 1967 Sep;22(5):387-96. doi: 10.1136/thx.22.5.387.
Twenty-three patients have had calf or pig heterograft aortic valve replacements. Eight of these patients have required Starr-Edwards mitral ball-valve prostheses for associated mitral valve disease. There have been two hospital deaths and one late death. The 20 surviving patients have shown symptomatic improvement. Clinical evidence of incompetence is present in one patient. Pre-operative and post-operative ciné-aortograms show valve mobility with a wide central orifice. Heterografts have the advantages of homografts in being free from thromboembolism and from the need for anticoagulants; they exhibit some resistance to infection as compared with prosthetic valves. We think that heterografts, because of their wider range of size, can offer a better haemodynamic result with little clinical aortic incompetence. The long-term fate of aortic valve heterografts is not known with certainty, although the durability of homografts is better known. There is a possibility of late degeneration or rupture. If the valve continues to function normally, then it would be justifiable to recommend operation at an earlier stage in the progression of the patient's disease. At present, despite encouraging early results, we think the use of heterografts should be limited, like that of other prostheses, to those patients who show severe cardiac disability.
23例患者接受了小牛或猪异种主动脉瓣置换术。其中8例患者因合并二尖瓣疾病而需要植入Starr-Edwards二尖瓣球瓣假体。有2例患者在医院死亡，1例患者晚期死亡。20例存活患者症状有所改善。1例患者存在瓣膜关闭不全的临床证据。术前和术后的主动脉造影显示瓣膜活动度良好，中央开口较宽。异种移植物具有同种移植物的优点，即无血栓栓塞风险且无需抗凝；与人工瓣膜相比，它们对感染有一定的抵抗力。我们认为，异种移植物由于其尺寸范围更广，能够提供更好的血流动力学结果，且临床主动脉瓣关闭不全的情况较少。虽然同种移植物的耐久性更为人所知，但主动脉瓣异种移植物的长期命运尚不确定。存在晚期退变或破裂的可能性。如果瓣膜继续正常发挥功能，那么在患者疾病进展的早期阶段推荐手术是合理的。目前，尽管早期结果令人鼓舞，但我们认为，与其他假体一样，异种移植物的使用应限于那些有严重心脏功能障碍的患者。
