Albertucci M, Wong K, Petrou M, Mitchell A, Somerville J, Theodoropoulos S, Yacoub M
Academic Department of Surgery, Harefield Hospital, Middlesex, England.
J Thorac Cardiovasc Surg. 1994 Jan;107(1):152-61.
Unstented homograft valves offer several theoretical advantages when used for patients who have had previous operations on the aortic valve. Between January 1970 and February 1993, 177 patients received unstented homograft valves after previous aortic valve operations. One hundred thirty-four patients had previous aortic valve replacement in the form of homografts (101 patients), mechanical prostheses (24 patients), and bioprostheses (9 patients), and 43 had previous valve repair. The indication for reoperation was deterioration of a noninfected valve (124 patients), infective endocarditis (40 patients), and failure of a noninfected mechanical valve (12 patients). Fresh homograft valves were implanted in 60 patients, homografts preserved in antibiotics were used in 111 patients, and 6 patients received cryopreserved valves. Aortic valve and root replacement was performed in 60 patients, and in 117 the homograft was inserted freehand in the subcoronary position. The early mortality was 5.1%. The actuarial survival at 10 years was 71%. Multivariate analysis demonstrated that patients with previous homograft replacement have a better long-term survival than patients who had previous mechanical valves (p = 0.017). The freedom from valve-related death and reoperation was 70% at 10 years. Fresh homografts faired better than antibiotic-sterilized homografts (p = 0.007). None of the patients had recurrence of endocarditis at 6 months, although 1 patient died of uncontrolled infection despite valve replacement. The freedom from recurrent endocarditis was 88% at 10 years. We conclude that unstented aortic homografts provide good early and long-term results for aortic valve reoperations, particularly in patients with previous homograft replacement. Recurrent endocarditis is uncommon even in patients operated on for prosthetic valve infections.
对于曾接受过主动脉瓣手术的患者，使用无支架同种异体瓣膜具有一些理论上的优势。1970年1月至1993年2月期间，177例患者在先前的主动脉瓣手术后接受了无支架同种异体瓣膜。134例患者先前接受过同种异体瓣膜置换（101例）、机械瓣膜置换（24例）和生物瓣膜置换（9例），43例患者先前接受过瓣膜修复。再次手术的指征为非感染性瓣膜恶化（124例）、感染性心内膜炎（40例）和非感染性机械瓣膜功能障碍（12例）。60例患者植入新鲜同种异体瓣膜，111例患者使用抗生素保存的同种异体瓣膜，6例患者接受冷冻保存的瓣膜。60例患者进行了主动脉瓣和根部置换，117例患者将同种异体瓣膜徒手植入冠状动脉下位置。早期死亡率为5.1%。10年的精算生存率为71%。多变量分析表明，先前接受同种异体瓣膜置换的患者比先前接受机械瓣膜置换的患者具有更好的长期生存率（p = 0.017）。10年时瓣膜相关死亡和再次手术的无事件生存率为70%。新鲜同种异体瓣膜的效果优于抗生素消毒的同种异体瓣膜（p = 0.007）。6个月时无患者发生心内膜炎复发，尽管1例患者在瓣膜置换后死于无法控制的感染。10年时复发性心内膜炎的无事件生存率为88%。我们得出结论，无支架主动脉同种异体瓣膜为主动脉瓣再次手术提供了良好的早期和长期效果，特别是对于先前接受同种异体瓣膜置换的患者。即使在因人工瓣膜感染而接受手术的患者中，复发性心内膜炎也不常见。
