Doty J R, Salazar J D, Liddicoat J R, Flores J H, Doty D B
Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md, USA.
J Thorac Cardiovasc Surg. 1998 Feb;115(2):371-9; discussion 379-80. doi: 10.1016/S0022-5223(98)70281-8.
Cryopreserved aortic allograft can be used for aortic valve replacement in congenital, rheumatic, degenerative, and infected native valve conditions, as well as failed prosthetic valves. This study was conducted to determine the long-term results of aortic valve replacement with cryopreserved aortic allografts.
Aortic valve replacement with cryopreserved aortic allografts was performed in 117 patients from July 1985 until August 1996. All patients requiring aortic valve replacement regardless of valve disease were considered for allograft replacement; the valve was preferentially used in patients under age 55 years and in the setting of bacterial endocarditis. Four operative techniques involving cryopreserved aortic allografts were used: freehand aortic valve replacement with 120-degree rotation, freehand aortic valve replacement with intact noncoronary sinus, aortic root enlargement with intact noncoronary sinus, and total aortic root replacement. Valve function was assessed by echocardiography during the operation in 78 patients (66%) and after the operation in 77 patients (65%).
One-hundred eighteen aortic valve replacements with cryopreserved aortic allografts were performed on 117 patients; mean age was 45.6 years (range 15 to 83 years) and mean follow-up was 4.6 years (range up to 11 years). Intraoperative echocardiography disclosed no significant aortic valve incompetence. There were four operative deaths (3%) and seven late deaths; freedom from valve-related mortality at 10 years was 9:3% +/- 4.55%. New York Heart Association functional status at latest follow-up was normal in 98 (94%) patients. On postoperative echocardiography, 90% had no or trivial aortic valve incompetence. Freedom from thromboembolism at 10 years was 100% and from endocarditis, 98% +/- 2.47%. Seven (6%) patients required valve explantation, four for structural deterioration. At 10 years, freedom from reoperation for allograft-related causes was 92% +/- 3.47%.
Aortic valve replacement with cryopreserved aortic allografts can be performed with low perioperative and long-term mortality. Most patients have excellent functional status, and reoperation for valve-related causes is unusual. Aortic valve replacement with cryopreserved aortic allografts demonstrates excellent freedom from thromboembolism, endocarditis, and progressive valve incompetence.
冷冻保存的主动脉同种异体移植物可用于先天性、风湿性、退行性和感染性自体瓣膜疾病以及人工瓣膜功能障碍的主动脉瓣置换。本研究旨在确定冷冻保存的主动脉同种异体移植物进行主动脉瓣置换的长期结果。
1985年7月至1996年8月期间，对117例患者进行了冷冻保存的主动脉同种异体移植物主动脉瓣置换术。所有需要主动脉瓣置换的患者，无论瓣膜疾病如何，均考虑进行同种异体移植物置换；该瓣膜优先用于55岁以下患者以及细菌性心内膜炎患者。使用了四种涉及冷冻保存的主动脉同种异体移植物的手术技术：120度旋转徒手主动脉瓣置换、完整无冠状动脉窦的徒手主动脉瓣置换、完整无冠状动脉窦的主动脉根部扩大以及全主动脉根部置换。78例患者（66%）在手术期间通过超声心动图评估瓣膜功能，77例患者（65%）在术后进行评估。
对117例患者进行了118次冷冻保存的主动脉同种异体移植物主动脉瓣置换术；平均年龄为45.6岁（范围15至83岁），平均随访时间为4.6年（范围长达11年）。术中超声心动图显示无明显主动脉瓣关闭不全。有4例手术死亡（3%）和7例晚期死亡；10年时瓣膜相关死亡率的无事件生存率为93%±4.55%。在最近一次随访时，98例（94%）患者的纽约心脏协会功能状态正常。术后超声心动图显示，90%的患者无或仅有轻微主动脉瓣关闭不全。10年时血栓栓塞的无事件生存率为100%，心内膜炎的无事件生存率为98%±2.47%。7例（6%）患者需要取出瓣膜，4例因结构恶化。10年时，因同种异体移植物相关原因再次手术的无事件生存率为92%±3.47%。
冷冻保存的主动脉同种异体移植物主动脉瓣置换术的围手术期和长期死亡率较低。大多数患者功能状态良好，因瓣膜相关原因再次手术的情况不常见。冷冻保存的主动脉同种异体移植物主动脉瓣置换术在预防血栓栓塞、心内膜炎和进行性瓣膜关闭不全方面表现出色。
