Staab M E, Nishimura R A, Dearani J A, Orszulak T A
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1998 Mar;73(3):231-8. doi: 10.4065/73.3.231.
Aortic valve replacement is a lifesaving measure in patients with severe aortic valve disease. In the United States, the most commonly used prostheses are the mechanical and bioprosthetic valves. With mechanical valves, long-term anticoagulation is necessary because of high thrombogenic potential. Bioprosthetic valves have a relatively high incidence of structural failure, especially in younger patients. Aortic valve homografts, derived from human heart donors or autopsy material, provide an alternative to mechanical or animal valves. The advantages of the homograft in comparison with the mechanical prostheses are the low incidence of thromboembolism without anticoagulation and lower valvular gradients in smaller sizes. Homografts are relatively resistant to endocarditis and are the valve of choice during active endocarditis. Their major mode of failure has been aortic regurgitation; however, recent advances in preservation and operative techniques have decreased this problem. Whether implantation of an aortic valve homograft should be the procedure of choice in subsets of patients remains controversial. Herein we review the history, techniques, results, complications, and current indications for aortic valve homografts.
主动脉瓣置换术是重度主动脉瓣疾病患者的一项挽救生命的措施。在美国，最常用的人工瓣膜是机械瓣膜和生物瓣膜。对于机械瓣膜，由于其高血栓形成潜力，长期抗凝是必要的。生物瓣膜存在相对较高的结构失效发生率，尤其是在年轻患者中。源自人类心脏供体或尸检材料的主动脉瓣同种异体移植物，为机械瓣膜或动物瓣膜提供了一种替代选择。与机械人工瓣膜相比，同种异体移植物的优点是无需抗凝时血栓栓塞发生率低，且较小尺寸时瓣膜压差较低。同种异体移植物相对不易发生心内膜炎，是活动性心内膜炎期间的首选瓣膜。其主要的失效模式一直是主动脉瓣反流；然而，保存和手术技术方面的最新进展已减少了这一问题。在某些患者亚组中，主动脉瓣同种异体移植物植入术是否应作为首选手术仍存在争议。在此，我们回顾主动脉瓣同种异体移植物的历史、技术、结果、并发症及当前适应证。
