Doty D B, Michielon G, Wang N D, Cain A S, Millar R C
LDS Hospital, Salt Lake City, Utah.
Ann Thorac Surg. 1993 Aug;56(2):228-35; discussion 235-6. doi: 10.1016/0003-4975(93)91152-d.
Replacement of the aortic valve with cryopreserved aortic allograft was performed in 88 patients during the period from July 1985 until January 1993. Age of patients ranged from 15 to 75 years (mean, 44 years). The cause of aortic valve disease was congenital in 39 (44%), rheumatic in 9 (10%), degenerative in 14 (16%), endocarditis in 11 (13%), and failed prosthesis in 15 (17%). The operation was performed by freehand allograft technique in 71 patients (81%). There were no perioperative deaths. Two patients died later at 4 months and 5 years after operation (actuarial survival = 94% at 7.5 years). Follow-up extending to 7.5 years shows 87% of patients are in New York Heart Association functional class I. No thromboembolism has been detected in any patient. Infection was cured in all patients with endocarditis. Mild aortic valve incompetence was detected by diastolic murmur in 45% of patients. Only three valves have been removed at reoperation: one was removed early for technical reasons, and two valves were removed for structural degeneration at 33 and 55 months; the latter was infected. Actuarial freedom from reoperation for any reason was 89%; for structural deterioration it was 93% at 7.5 years. Aortic valve replacement with cryopreserved aortic allograft can be safely performed in adult patients. Medium-term results show excellent freedom from thromboembolism and cure of bacterial endocarditis. Mild aortic valve incompetence is often present, but reoperation for progressive incompetence is unusual.
1985年7月至1993年1月期间，88例患者接受了低温保存主动脉同种异体移植主动脉瓣置换术。患者年龄在15至75岁之间（平均44岁）。主动脉瓣疾病的病因中，先天性的有39例（44%），风湿性的9例（10%），退行性的14例（16%），心内膜炎的11例（13%），人工瓣膜失效的15例（17%）。71例患者（81%）采用徒手同种异体移植技术进行手术。围手术期无死亡病例。两名患者分别在术后4个月和5年死亡（7.5年的实际生存率为94%）。随访至7.5年显示，87%的患者纽约心脏协会心功能分级为I级。未在任何患者中检测到血栓栓塞。所有心内膜炎患者的感染均已治愈。45%的患者通过舒张期杂音检测到轻度主动脉瓣关闭不全。再次手术时仅取出了3个瓣膜：1个因技术原因早期取出，2个瓣膜分别在33个月和55个月因结构退变取出；后者发生了感染。因任何原因再次手术的实际免发生率为89%；因结构恶化再次手术的免发生率在7.5年时为93%。低温保存主动脉同种异体移植主动脉瓣置换术可在成年患者中安全进行。中期结果显示血栓栓塞和细菌性心内膜炎治愈的免发生率极佳。常存在轻度主动脉瓣关闭不全，但因进行性关闭不全而再次手术的情况并不常见。
