O'Brien M F, Stafford E G, Gardner M A, Pohlner P G, Tesar P J, Cochrane A D, Mau T K, Gall K L, Smith S E
Department of Cardiac Surgery, Prince Charles Hospital, Brisbane, Australia.
Ann Thorac Surg. 1995 Aug;60(2 Suppl):S65-70. doi: 10.1016/0003-4975(95)00223-8.
Aortic valve replacement using an allograft aortic valve has been performed on 804 patients. From December 1969 to May 1975, 124 patients received a nonviable allograft valve sterilized by incubation with low-dose antibiotics and stored for weeks by refrigeration at 4 degrees C (series 1). From June 1975 to January 1994, 680 patients received viable allograft valves, now cryopreserved early within 2 hours of collection from transplant recipient donors, 6 hours for multiorgan donor valves and 23 hours (mean) for autopsy valves from donor death. The 30-day mortality was 8.9% +/- 5% (95% confidence limits) for series I and 2.8% +/- 1% (95% confidence limits) for series II. Actuarial patient survival including hospital mortality at 15 years was 56% +/- 5% for series I and 62% +/- 5% for series II. The probability of a thromboembolic event was low, freedom at 15 years being 95% +/- 1% for patients receiving allografts with or without associated coronary bypass procedures and 81% +/- 5% for patients having allografts with other associated procedures (eg, mitral valve operations). Actuarial freedom from endocarditis was similar for the two series, 91% +/- 3% (series I) and 94% +/- 2% (series II) at 15 years. The freedom from valve incompetence, from reoperation for all causes, and from structural deterioration demonstrated clearly the inferiority of the 4 degrees C stored allograft valves. For structural deterioration as identified clinically, at reoperation and at death, freedom from this event at 15 years was 45% +/- 6% for series I and 80% +/- 5% for series II (p value for the difference is 0).(ABSTRACT TRUNCATED AT 250 WORDS)
804例患者接受了同种异体主动脉瓣置换术。1969年12月至1975年5月，124例患者接受了经低剂量抗生素孵育灭菌并在4℃冷藏数周的非活性同种异体瓣膜（系列1）。1975年6月至1994年1月，680例患者接受了活性同种异体瓣膜，现在在从移植受体供体采集后2小时内早期冷冻保存，多器官供体瓣膜为6小时，尸检瓣膜从供体死亡起平均为23小时。系列1的30天死亡率为8.9%±5%（95%置信区间），系列2为2.8%±1%（95%置信区间）。包括15年医院死亡率在内的患者精算生存率，系列1为56%±5%，系列2为62%±5%。血栓栓塞事件的发生率较低，接受同种异体移植（无论是否伴有冠状动脉搭桥手术）的患者15年无血栓栓塞事件的概率为95%±1%，接受同种异体移植并伴有其他相关手术（如二尖瓣手术）的患者为81%±5%。两个系列的心内膜炎精算无病生存率相似，15年时系列1为91%±3%，系列2为94%±2%。瓣膜关闭不全、因各种原因再次手术以及结构恶化的无病生存率清楚地表明了4℃保存的同种异体瓣膜的劣势。对于临床确定、再次手术和死亡时发现的结构恶化，系列1患者15年无此事件的概率为45%±6%，系列2为80%±5%（差异的p值为0）。（摘要截断于250字）
