Niwaya K, Knott-Craig C J, Lane M M, Chandrasekaren K, Overholt E D, Elkins R C
Section of Thoracic and Cardiovascular Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA.
J Thorac Cardiovasc Surg. 1999 Jan;117(1):141-6; discussion 46-7. doi: 10.1016/s0022-5223(99)70479-4.
The purpose of this study was to examine the durability of cryopreserved homografts used to replace the "pulmonary" valve and to identify factors associated with their late deterioration.
We reviewed our entire experience (1985-1997) with 331 survivors in whom cryopreserved homograft valves (pulmonary, n = 304; aortic, n = 27) were used to reconstruct the pulmonary outflow tract. Median age was 14 years (range, 2 days-62 years). Operations included Ross operation (n = 259), tetralogy of Fallot (n = 41), truncus arteriosus (n = 14), Rastelli operation (n = 11), and others (n = 6). Median follow-up was 3.8 years (range, 0.2-11.2 years); late echographic follow-up was complete for 97% of patients. Homograft failure was defined as the need for explantation and valve-related death; homograft dysfunction was defined as a pulmonary insufficiency grade 3/4 or greater and a transvalvular gradient of 40 mm Hg or greater.
Homograft failure occurred in 9% (30 of 331 patients; Kaplan-Meier); freedom from failure was 82% +/- 4% at 8 years. Homograft dysfunction occurred in 12% (39 of 331 patients), although freedom from dysfunction was 76% +/- 4% at 8 years. For aortic homografts, this was 56% +/- 11%, compared to 80% +/- 4% for pulmonary homografts (P =.003). For patients aged less than 3 years (n = 38), this was 51% +/- 12%, compared with 87% +/- 4% for older patients (P =.0001). By multivariable analysis, younger age of homograft donors, non-Ross operation, and later year of operation were associated with homograft failure; younger age of homograft donors, later year of operation, and use of an aortic homograft were associated with homograft dysfunction.
Homograft valves function satisfactorily in the pulmonary position at mid-term follow-up. The pulmonary homograft valve appears to be more durable than the aortic homograft valve in the pulmonary position.
本研究旨在检验用于替换“肺动脉”瓣的冷冻保存同种异体移植物的耐久性，并确定与其后期退化相关的因素。
我们回顾了1985年至1997年期间331名幸存者的全部病历，这些患者使用冷冻保存的同种异体瓣膜（肺动脉瓣，n = 304；主动脉瓣，n = 27）重建肺动脉流出道。中位年龄为14岁（范围为2天至62岁）。手术包括Ross手术（n = 259）、法洛四联症手术（n = 41）、动脉干手术（n = 14）、Rastelli手术（n = 11）以及其他手术（n = 6）。中位随访时间为3.8年（范围为0.2至11.2年）；97%的患者完成了后期超声心动图随访。同种异体移植物失败定义为需要进行瓣膜置换及与瓣膜相关的死亡；同种异体移植物功能障碍定义为肺动脉瓣反流3/4级或更高，且跨瓣压差为40 mmHg或更高。
同种异体移植物失败发生率为9%（331例患者中有30例；Kaplan-Meier法）；8年时无失败的生存率为82%±4%。同种异体移植物功能障碍发生率为12%（331例患者中有39例），8年时无功能障碍的生存率为76%±4%。主动脉同种异体移植物的这一比例为56%±11%，而肺动脉同种异体移植物为80%±4%（P = 0.003）。年龄小于3岁的患者（n = 38）这一比例为51%±12%，而年龄较大患者为87%±4%（P = 0.0001）。多变量分析显示，同种异体移植物供体年龄较小、非Ross手术以及手术年份较晚与同种异体移植物失败相关；同种异体移植物供体年龄较小、手术年份较晚以及使用主动脉同种异体移植物与同种异体移植物功能障碍相关。
在中期随访中，同种异体瓣膜在肺动脉位置功能良好。肺动脉同种异体瓣膜在肺动脉位置似乎比主动脉同种异体瓣膜更耐用。
