牛心包用于肺动脉瓣重建或管道置换的长期临床随访。

The use of bovine pericardium for pulmonary valve reconstruction or conduit replacement: long-term clinical follow up.

作者信息

Vrandecic M, Filho B G, Fantini F, Barbosa J, Martins I, Cesar de Oliveira O, Martins C, Max R, Drumond L, Oliveira C, Ferrufino A, Alcocer E, Silva J A, Vrandecic E

机构信息

Biocor Institute, Belo Horizonte, MG, Brazil.

出版信息

J Heart Valve Dis. 1998 Jan;7(1):54-61.

PMID:9502140

Abstract

BACKGROUND AND AIMS OF THE STUDY

This study aimed to determine the clinical performance of bovine pericardial aldehyde-treated material alone or in combination with aortic leaflets of porcine origin. These were the porcine aortic stentless pulmonary valved bovine pericardial conduit (PSPVC), and porcine aortic monocusp attached to pericardial patch (PAMC), used to correct right-sided heart lesions.

METHODS

Between November 1985 and October 1995, 33 patients underwent corrective congenital surgery with PSPVC. Mean patient age was 5.7+/-4.3 years (range: 15 days to 18 years). Pulmonary atresia with ventricular septal defect (VSD) was the most frequent disease (16/33, 48%). For PAMC, 45 patients with various congenital heart malformations underwent implantation between June 1989 and April 1996. Mean patient age was 4.8+/-4.7 years (range: 2 weeks to 18 years).

RESULTS

With PSPVC, hospital mortality rate was 18.2% and related to poor preoperative clinical condition in six cases. Four patients were lost to follow up; 23 (85%) were followed for 3 months to 10 years (mean 4.8+/-3.0 years). Distal anastomotic scarring in four patients was probably due to retraction of the pericardial tissue. With PAMC, hospital mortality rate was 11% and related to patients' preoperative clinical condition. Three patients were lost to follow up; 37 survivors have been followed for 6 to 88 months (mean 38.5+/-19.0 months). There were no late deaths. Two patients underwent reoperation; intra-operative observation showed well-preserved monocusps with no signs of tissue degeneration. The remaining 35 patients remain asymptomatic by clinical examination and Doppler echocardiography. The monocusps remained mobile in every case.

CONCLUSION

PSPVCs have shown excellent performance and durability in young patients with a low mean age (5 years). The monocusp graft has remained functional with good leaflet motion for up to seven years.

摘要

研究背景与目的

本研究旨在确定单独使用经醛处理的牛心包材料或与猪源主动脉瓣叶联合使用时的临床性能。这些材料包括猪主动脉无支架带瓣牛心包管道（PSPVC）和附着于心包补片的猪主动脉单叶瓣（PAMC），用于矫正右心病变。

方法

1985年11月至1995年10月期间，33例患者接受了PSPVC矫正先天性手术。患者平均年龄为5.7±4.3岁（范围：15天至18岁）。肺动脉闭锁合并室间隔缺损（VSD）是最常见的疾病（16/33，48%）。对于PAMC，1989年6月至1996年4月期间，45例患有各种先天性心脏畸形的患者接受了植入手术。患者平均年龄为4.8±4.7岁（范围：2周至18岁）。

结果

使用PSPVC时，医院死亡率为18.2%，6例与术前临床状况不佳有关。4例患者失访；23例（85%）随访3个月至10年（平均4.8±3.0年）。4例患者远端吻合口瘢痕形成可能是由于心包组织回缩。使用PAMC时，医院死亡率为11%，与患者术前临床状况有关。3例患者失访；37例幸存者随访6至88个月（平均38.5±19.0个月）。无晚期死亡病例。2例患者接受了再次手术；术中观察显示单叶瓣保存良好，无组织退变迹象。其余35例患者经临床检查和多普勒超声心动图检查均无症状。每个病例中的单叶瓣均保持活动。