Farina G, Cerasuolo F, De Luca Tupputi Schinosa L, De Siena P M, Scardone M, Zangani P, Mangoni E D, Piazza L, Cotrufo M
Istituto Medico Chirurgico di Cardiologia, Facoltà di Medicina Legale, Seconda Università Degli Studi di Napoli.
G Ital Cardiol. 1994 Aug;24(8):965-72.
A homograft bank was established in 1986 at the Institute of Cardiac Surgery of the Second University of Naples. Since then 163 aortic and pulmonary homografts have been collected, and mostly used for right ventricular outflow tract reconstruction (69 at our Institution and 14 at other Italian Centers). In March 1991 free aortic homografts were first implanted in the left ventricular outflow tract in adult patients with aortic valve and/or root disease, for a total of 15 implantations with a follow-up ranging between 3 and 19 months (mean 10 months). According to the literature and our data, operative mortality for such procedure is not higher than for ordinary aortic valve replacement. With regard to mid-term failure rate and complications, homografts are to be preferred as they don't require anticoagulation. Moreover the best indication to free homograft implantation is active aortic valve endocarditis, especially when annular abscesses are present. Reinfection rate is lesser in these patients compared to those with mechanical or bioprosthetic valves because homografts have no prosthetic material, allow exclusion of abscessual cavities from blood flow and do not require the fixation of a rigid prosthetic sewing ring in an infected, friable annulus. Finally short and mid-term haemodynamic evaluations of such patients are excellent for all the aforementioned reasons as well as for the homograft non obstruction rate.
1986年，那不勒斯第二大学心脏外科研究所建立了一个同种异体移植库。自那时以来，已收集了163个主动脉和肺动脉同种异体移植物，主要用于右心室流出道重建（在我们机构使用了69个，在其他意大利中心使用了14个）。1991年3月，首次在患有主动脉瓣和/或根部疾病的成年患者的左心室流出道植入游离主动脉同种异体移植物，共进行了15次植入，随访时间为3至19个月（平均10个月）。根据文献和我们的数据，该手术的手术死亡率不高于普通主动脉瓣置换术。关于中期失败率和并发症，同种异体移植物更可取，因为它们不需要抗凝。此外，游离同种异体移植物植入的最佳适应症是活动性主动脉瓣心内膜炎，尤其是当存在瓣周脓肿时。与使用机械瓣膜或生物假体瓣膜的患者相比，这些患者的再感染率较低，因为同种异体移植物没有假体材料，可使脓肿腔与血流隔离，并且不需要在感染、易碎的瓣环中固定刚性假体缝合环。最后，由于上述所有原因以及同种异体移植物无梗阻率，对这些患者进行的短期和中期血流动力学评估结果极佳。
