Willems T P, Bogers A J, Cromme-Dijkhuis A H, Steyerberg E W, van Herwerden L A, Hokken R B, Hess J, Bos E
Department of Cardio-Pulmonary Surgery, University Hospital Sophia-Dijkzigt, Rotterdam, The Netherlands.
Eur J Cardiothorac Surg. 1996;10(8):609-14; discussion 614-5. doi: 10.1016/s1010-7940(96)80374-5.
Evaluation of allograft reconstruction of the right ventricular outflow tract (RVOT).
From 1986 to April 1995, 201 allografts (146 pulmonary, 55 aortic) were implanted in 189 patients for conduit reconstruction of the RVOT in congenital heart disease or in the pulmonary autograft procedure. The mean age at allograft implantation was 16 years (range 2 weeks - 54 years). The primary diagnoses of these patients were truncus arterious (n = 19, 10%), transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary atresia (PA) or stenosis (PS) (n = 14, 7%), PA with VSD (n = 26, 14%), PA or PS with intact septum (n = 7, 4%), tetralogy of Fallot (n = 44, 23%), corrected TGA with PA or PS (n = 11, 6%), tricuspid atresia (n = 9, 5%), aortic valve pathology for pulmonary autograft procedure (n = 55, 29%), and miscellaneous (n = 4, 2%). The allograft implantation was a reoperation in 54 patients (29%).
The mean follow-up was 2.5 years (range 4 weeks-9 years). Six patients died in hospital (3.2%). Patient survival at 5 years was 91% (95% CL 86-95%). Freedom from all valve-related events (2 deaths, 17 reoperations, one endocarditis), as determined during reoperation or autopsy at 5 years was 78% (95% CL 65-86%). Freedom from structural allograft failure was 83% (2 deaths, 12 reoperations, 95% CL 70-90%). Allografts implanted for congenital right heart defects failed earlier than allografts used for pulmonary autograft procedures (P = 0.05). Aortic allografts showed structural failure more often than pulmonary allografts (P = 0.05). There were more valve-related events in patients of a younger age at implantation (P = 0.02) and in those allograft valves from younger donors (P = 0.004).
Allograft RVOT reconstruction is an adequate surgical therapy. The allograft should preferably be pulmonary. A younger age at implantation is a risk factor for allograft failure. Donor age may be a thus-far underestimated risk factor for allograft degeneration.
评估右心室流出道（RVOT）同种异体移植重建情况。
1986年至1995年4月，189例患者植入了201个同种异体移植物（146个肺动脉瓣，55个主动脉瓣），用于先天性心脏病右心室流出道的管道重建或肺动脉自体移植手术。同种异体移植物植入时的平均年龄为16岁（范围2周 - 54岁）。这些患者的主要诊断包括永存动脉干（n = 19，10%）、大动脉转位（TGA）合并室间隔缺损（VSD）及肺动脉闭锁（PA）或狭窄（PS）（n = 14，7%）、PA合并VSD（n = 26，14%）、PA或PS合并完整室间隔（n = 7，4%）、法洛四联症（n = 44，23%）、矫正性TGA合并PA或PS（n = 11，6%）、三尖瓣闭锁（n = 9，5%）、用于肺动脉自体移植手术的主动脉瓣病变（n = 55，29%）以及其他（n = 4，2%）。54例患者（29%）的同种异体移植物植入为再次手术。
平均随访时间为2.5年（范围4周 - 9年）。6例患者在医院死亡（3.2%）。5年时患者生存率为91%（95%可信区间86 - 95%）。5年时通过再次手术或尸检确定的无所有瓣膜相关事件（2例死亡、17例再次手术、1例心内膜炎）发生率为78%（95%可信区间65 - 86%）。同种异体移植物无结构衰竭发生率为83%（2例死亡、12例再次手术，95%可信区间70 - 90%）。用于先天性右心缺陷的同种异体移植物比用于肺动脉自体移植手术的同种异体移植物更早失效（P = 0.05）。主动脉同种异体移植物比肺动脉同种异体移植物更常出现结构衰竭（P = 0.05）。植入时年龄较小的患者以及来自较年轻供体的同种异体瓣膜患者发生瓣膜相关事件更多（P = 0.02和P = 0.004）。
同种异体RVOT重建是一种合适的外科治疗方法。同种异体移植物最好选用肺动脉瓣。植入时年龄较小是同种异体移植物失败的危险因素。供体年龄可能是迄今为止被低估的同种异体移植物退变危险因素。
