Mair R, Peschl F, Gross C, Klima U, Hinterreiter H, Bruecke P
Departement of Surgery I, General Hospital Linz, Austria.
Eur J Cardiothorac Surg. 1997 May;11(5):910-6. doi: 10.1016/s1010-7940(97)01213-x.
The advantages of the aortic valve homograft high resistance to infective endocarditis, low risk of thromboembolism, low gradient and excellent long term results are well known. Trying to extend these advantages to a greater number of patients, we used pulmonary homografts as aortic valve substitute, based on the experimental evidence, that they can withstand the higher stress in systemic circulation.
From September 1988 to August 1994 175 patients (103 men, 72 women, mean age 61.75 +/- 12.92 years) underwent aortic valve replacement with a cryopreserved pulmonary homograft. All valves were taken from our own homograft bank. They were inserted freehand intraaortically, 162 in subcoronary position, 13 as intraaortic cylinder. All patients were followed clinically and by colorflow Doppler echocardiography in 3-12 month intervals.
Patients, 8, died perioperatively (4.57%). None of the deaths was valve related. Patients, 2, had to be reoperated during the perioperative period due to severe valvular incompetence 165 patients were followed up to a period of 7.5 years (mean interval 3.83 +/- 1.45 years). Patients, 30, died, 13 deaths (7.42%) must be regarded as valve related. Patients, 22, (12.52%) had to be reoperated due to severe graft incompetence. Patients, 9 (5.14%), acquired prosthetic endocarditis.
Due to our results, high rate of valve related deaths, high rate of graft failure and high rate of prosthetic endocarditis, we must state that the pulmonary homograft did not fulfil our expectations and presently we can not recommend it as an aortic valve substitute.
主动脉瓣同种异体移植具有抗感染性心内膜炎能力强、血栓栓塞风险低、压力阶差小以及长期效果良好等优点，这是众所周知的。为了将这些优点应用于更多患者，基于实验证据，即肺动脉同种异体移植物能够承受体循环中的更高压力，我们使用肺动脉同种异体移植物作为主动脉瓣替代物。
1988年9月至1994年8月，175例患者（男103例，女72例，平均年龄61.75±12.92岁）接受了冷冻保存的肺动脉同种异体主动脉瓣置换术。所有瓣膜均取自我们自己的同种异体移植物库。它们通过徒手操作植入主动脉内，162例置于冠状动脉下位置，13例作为主动脉内柱状移植物。所有患者均接受临床随访，并每隔3 - 12个月进行彩色多普勒超声心动图检查。
8例患者围手术期死亡（4.57%）。无一例死亡与瓣膜相关。2例患者因严重瓣膜功能不全在围手术期不得不再次手术。165例患者随访了7.5年（平均间隔3.83±1.45年）。30例患者死亡，其中13例死亡（7.42%）必须视为与瓣膜相关。22例患者（12.52%）因严重移植物功能不全不得不再次手术。9例患者（5.14%）发生人工瓣膜心内膜炎。
基于我们的结果，即与瓣膜相关的高死亡率、高移植物失败率和高人工瓣膜心内膜炎发生率，我们必须指出，肺动脉同种异体移植物未达到我们的期望，目前我们不能推荐将其作为主动脉瓣替代物。
