Performance of SynerGraft Decellularized Pulmonary Homograft in Patients Undergoing a Ross Procedure
Performance of SynerGraft Decellularized Pulmonary Homograft in Patients Undergoing a Ross Procedure
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DOI：
10.1016/j.athoracsur.2010.10.069
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发表时间：
2011-02-01
影响因子：
4.6
通讯作者：
Turrentine, Mark W.
中科院分区：
文献类型：
--
作者：
Brown, John W.;Ruzmetov, Mark;Turrentine, Mark W.
背景。在罗斯主动脉瓣置换术（AVR）中，肺同种异体移植物通常取代自体移植的肺动脉瓣。尽管Ross与其他AVR手术相比有优势，但同种异体结构瓣膜早期恶化的风险很小，但不可预测，通常表现为收缩和右心室流出道梗阻。本研究分析了我们使用一种新的CryoValve SynerGraft （Cryo-Life Inc, Kennesaw， GA）脱细胞肺同种异体移植物（SGDPA）治疗Ross AVR的结果，并将其与同期使用的标准冷冻保存同种异体移植物（SCA）进行了比较。2000年至2009年间，在Ross AVR期间，29名患者接受了SGDPA， 34名患者接受了SCA。患者种植时的平均年龄为28.6±16.0岁（4个月至58岁）。回顾性数据包括报告的不良事件，并收集最新的血流动力学数据。在平均4.9±2.7年（2个月至9年）的随访期间，未发生早期或晚期死亡或重大发病事件。无患者需要导管再手术。放电时峰梯度中位数为12 mm Hg，末次随访无显著性差异。SGDPA组导管瓣膜功能未发生恶化。几例SCA患者出现轻度导管返流，1例患者出现中度返流。没有患者达到我们对导管功能障碍的定义（峰值梯度：40mmhg或bbb2 +反流）。SGDPA导管是罗斯AVR的SCA的替代方案。早期临床和血流动力学结果令人鼓舞，但与SCA没有显著差异。SynerGraft技术可以为需要右心室流出道重建的患者提供更持久的选择。需要进一步的长期随访来观察这种脱细胞过程是否能提高同种异体移植物的长期耐久性。（Ann Thorac surgery; 2011;91:416-23） (C) 2011年由胸外科医师协会出版
Background. In the Ross aortic valve replacement (AVR), a pulmonary allograft normally replaces the autotransplanted pulmonary valve. Despite the Ross advantages vs other AVR procedures, there has been a small but unpredictable risk of early structural allograft valve deterioration, usually manifested by shrinkage and right ventricular outflow tract obstruction. This study analyzed our results of the Ross AVR using a new CryoValve SynerGraft (Cryo-Life Inc, Kennesaw, GA) decellularized pulmonary allograft (SGDPA) and compared it with the standard cryopreserved allograft (SCA) used during the same period.Methods. Between 2000 and 2009, 29 patients received a SGDPA and 34 received the SCA during Ross AVR. Patients were a mean age at implant of 28.6 +/- 16.0 years (range, 4 months to 58 years). Retrospective data included reported adverse events, and the most recent hemodynamic data were collected.Results. No early or late deaths or significant morbid events occurred during the mean follow-up of 4.9 +/- 2.7 years (range, 2 months to 9 years). No patient required conduit reoperation. The median peak gradient at discharge was 12 mm Hg and was not significant at last follow-up. No deterioration in conduit valve function occurred in the SGDPA group. Mild conduit regurgitation developed in several SCA patients, and one patient had moderate regurgitation. No patient reached our definition of conduit dysfunction (peak gradient: 40 mm Hg or > 2+ regurgitation).Conclusions. The SGDPA conduit is an alternative to the SCA for the Ross AVR. The early clinical and hemodynamic results are encouraging but were not significantly different from the SCA. SynerGraft technology may provide a more durable option for patients who need right ventricular outflow tract reconstruction. Further long-term follow-up is needed to see if this decellularization process improves long-term allograft durability. (Ann Thorac Surg 2011;91:416-23) (C) 2011 by The Society of Thoracic Surgeons