Duran C M, Gometza B, Kumar N, Gallo R, Martin-Duran R
Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
J Thorac Cardiovasc Surg. 1995 Aug;110(2):511-6. doi: 10.1016/S0022-5223(95)70248-2.
Fifty-one patients with a mean age of 31.2 years underwent aortic valve replacement with glutaraldehyde-treated autologous pericardium. Pure aortic regurgitation was present in 28 (54.9%), stenosis in 9, and mixed disease in 14. Simultaneous mitral valve repair was done in 17 patients and replacement in 1. There were no hospital and two late deaths. Three patients required reoperation because of failure of the pericardial valve as a result of infective endocarditis in two (5 and 31 months after operation) and commissural tear at 8 months in another. One patient underwent reoperation at 24 months because of failure of the mitral valve repair. The pericardial aortic valve, which had 2+ regurgitation since the first operation, was also replaced. Macroscopic and microscopic examination findings in the excised pericardium were excellent. No thromboembolic events have been detected and no patient received anticoagulation therapy except one after mitral valve reoperation and replacement with a mechanical valve. The actuarial survival was 84.53% +/- 12.29% at 60 months, freedom from failure of the aortic reconstruction 83.83% +/- 8.59%, and freedom from any event 72.59% +/- 12.79%. Doppler echocardiographic study at most recent follow-up showed a mean gradient of 12.56 +/- 8.10 mm Hg and mean regurgitation on a scale from 0 to 4+ of 0.80 +/- 0.66. Although the maximum follow-up is only 5 years, the results obtained so far encourage us to continue replacing the aortic valve with stentless autologous pericardium.
51例平均年龄31.2岁的患者接受了用戊二醛处理的自体心包进行主动脉瓣置换术。28例（54.9%）为单纯主动脉瓣反流，9例为狭窄，14例为混合性病变。17例患者同时进行了二尖瓣修复，1例进行了二尖瓣置换。无住院死亡病例，2例为晚期死亡。3例患者因心包瓣膜功能障碍需要再次手术，其中2例（术后5个月和31个月）因感染性心内膜炎，另1例在术后8个月因瓣叶撕裂。1例患者在术后24个月因二尖瓣修复失败进行了再次手术。首次手术后一直存在2+反流的心包主动脉瓣也进行了置换。切除的心包的宏观和微观检查结果良好。未检测到血栓栓塞事件，除1例二尖瓣再次手术并置换机械瓣膜的患者外，无患者接受抗凝治疗。60个月时的精算生存率为84.53%±12.29%，主动脉重建无失败生存率为83.83%±8.59%，无任何事件生存率为72.59%±12.79%。最近一次随访时的多普勒超声心动图研究显示，平均压差为12.56±8.10 mmHg，反流程度平均为0至4+级中的0.80±0.66级。尽管最长随访时间仅5年，但目前获得的结果鼓励我们继续用无支架自体心包置换主动脉瓣。
