Fiane A E, Lindberg H L, Seem E, Geiran O R
Department of Surgery A, Rikshospitalet, University of Oslo, Norway.
Scand Cardiovasc J. 1997;31(6):351-6. doi: 10.3109/14017439709075952.
In 49 patients aged 2.2-34.8 (mean 11) years, homografts (20 aortic, 29 pulmonary) were implanted in the right ventricular outflow tract as an isolated procedure or part of corrective surgery for congenital heart disease: tetralogy of Fallot with pulmonary stenosis (23 cases), pulmonary atresia with ventricular septal defect (10 cases) truncus arteriosus (8 cases) or transposition of the great arteries with pulmonary stenosis (8 cases). Previous palliative procedures had been performed on 34 patients, and 37 had undergone repair of right ventricular outflow tract, with one to four sternotomies prior to homograft implantation. Homograft valve sizes ranged from 14 to 25 mm internal diameter. Concomitant intra- or extracardiac procedures were performed in 29 cases. Follow-up was complete at a mean of 3 +/- 0.3 (0-8) years. Early and total mortality was 2.0% (1/49), due to sepsis and multi-organ failure unrelated to the homograft. At follow-up all but one of the patients had an improved New York Heart Association function class. Eight patients (16.3%) with a mean age of 9.2 +/- 1.8 (2.8-15.5) years at implantation had homograft malfunction (stenosis in three, regurgitation in two and combined in three) at follow-up, averaging 4.1 +/- 1.0 (0.4-6.9) years, with no significant difference between aorta and pulmonary homograft subsets. Freedom from structural valve deterioration was 46.6 +/- 22% for pulmonary and 32.3 +/- 21.3% for aortic homografts at the 7-year follow-up (difference not significant). In two patients an aortic homograft was uneventfully replaced. In conclusion, homograft implantation in patients with right ventricular outflow tract obstruction improves function class and can entail low mortality and morbidity, even after multiple previous median sternotomies.
在49例年龄为2.2至34.8岁（平均11岁）的患者中，同种异体移植物（20个主动脉瓣、29个肺动脉瓣）作为单独手术或先天性心脏病矫正手术的一部分植入右心室流出道：法洛四联症合并肺动脉狭窄（23例）、室间隔缺损合并肺动脉闭锁（10例）、永存动脉干（8例）或大动脉转位合并肺动脉狭窄（8例）。34例患者曾接受过姑息性手术，37例曾接受过右心室流出道修复，在植入同种异体移植物之前进行过1至4次胸骨切开术。同种异体瓣膜内径范围为14至25毫米。29例患者同时进行了心内或心外手术。平均随访3±0.3（0至8）年，随访完整。早期和总死亡率为2.0%（1/49），原因是败血症和多器官功能衰竭，与同种异体移植物无关。随访时，除1例患者外，所有患者的纽约心脏协会功能分级均有所改善。8例患者（16.3%）植入时平均年龄为9.2±1.8（2.8至15.5）岁，随访时出现同种异体移植物功能障碍（3例狭窄、2例反流、3例两者兼有），平均时间为4.1±1.0（0.4至6.9）年，主动脉和肺动脉同种异体移植物亚组之间无显著差异。7年随访时，肺动脉同种异体移植物无结构瓣膜退变的发生率为46.6±22%，主动脉同种异体移植物为32.3±21.3%（差异无统计学意义）。2例患者的主动脉同种异体移植物顺利置换。总之，右心室流出道梗阻患者植入同种异体移植物可改善功能分级，即使在多次先前正中胸骨切开术后，死亡率和发病率也可能较低。
