Performance of bovine pericardial valves in the pulmonary position.
Performance of bovine pericardial valves in the pulmonary position.
复制标题
牛心包瓣膜在肺位置的性能。
DOI：
10.1016/j.athoracsur.2010.06.021
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Azakie,Anthony
中科院分区：
文献类型：
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作者：
Shinkawa,Takeshi;Anagnostopoulos,PetrosV;Johnson,NatalieC;Watanabe,Naruhito;Sapru,Anil;Azakie,Anthony
研究目的：本研究的目的是确定牛心包瓣在肺动脉位置的结果和性能。方法：本研究回顾性分析了2002年至2009年在一家机构使用牛心包瓣进行肺动脉瓣置换术的所有先天性心脏病患者。共有73例连续患者，中位年龄为17.3岁。（范围：2.1至64.4）。他们的诊断是法洛四联症（n = 47），肺动脉狭窄（n = 11），或其他（n = 15）。69例患者既往接受过91次外科手术。距上次手术的平均时间为19.9 ± 11.6年。43例患者同时接受了外科手术。无围手术期死亡。68例患者（93%）进行了临床随访。无晚期死亡，所有患者在中位随访2.6年（范围0.2 - 8.0）期间均为纽约心脏协会功能I级。1例患者在术后2年发生心内膜炎，需要移除瓣膜。1年、3年和5年时无肺动脉瓣再手术率分别为100%、97.7%和97.7%（95%置信区间：93.2%-100%）。随访时平均肺动脉瓣压差为19 ± 14 mm Hg。肺功能不全程度低于中度者62例，中度者4例，中度以上者2例。无中度-重度或重度肺功能不全分别为97.7%，89.1%和89.1%，在1，3和5年，分别（5年95%置信区间：77.0%至100%）。需要进一步随访以评价牛心包瓣膜在肺位置的长期性能。
BACKGROUNDThe purpose of this study is to determine the outcome and performance of bovine pericardial valves in the pulmonary position.METHODSThis is a retrospective review of all patients with congenital heart disease who had pulmonary valve replacement using a bovine pericardial valve from 2002 to 2009 at a single institution.RESULTSThere were 73 consecutive patients, with a median age of 17.3 years (range, 2.1 to 64.4). Their diagnosis was tetralogy of Fallot (n = 47), pulmonary stenosis (n = 11), or other (n = 15). Sixty-nine patients had 91 previous surgical procedures. The mean time from last surgery was 19.9 ± 11.6 years. Forty-three patients had concomitant surgical procedures. There were no perioperative deaths. Clinical follow-up was available in 68 patients (93%). There were no late deaths, and all patients were in New York Heart Association functional class I during a median follow-up period of 2.6 years (range, 0.2 to 8.0). One patient had endocarditis necessitating valve removal 2 years after surgery. Freedom from pulmonary valve reoperation was 100%, 97.7%, and 97.7% at 1, 3, and 5 years, respectively (95% confidence interval: 93.2% to 100%). Mean pulmonary valve gradient at follow-up was 19 ± 14 mm Hg. Degree of pulmonary insufficiency was less than moderate in 62 patients, moderate in 4, and more than moderate in 2. Freedom from moderate-severe or severe pulmonary insufficiency was 97.7%, 89.1%, and 89.1% at 1, 3, and 5 years, respectively (5-year 95% confidence interval: 77.0% to 100%).CONCLUSIONSPulmonary valve replacement using a bovine pericardial valve can be accomplished with low perioperative morbidity and favorable midterm outcomes. Further follow-up is necessary to evaluate the long-term performance of bovine pericardial valves in the pulmonary position.