Immunological and echocardiographic evaluation of decellularized versus cryopreserved allografts. during the Ross operation
Immunological and echocardiographic evaluation of decellularized versus cryopreserved allografts. during the Ross operation
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DOI：
10.1016/j.ejcts.2004.12.057
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发表时间：
2005-04-01
影响因子：
3.4
通讯作者：
Konertz, W
中科院分区：
文献类型：
--
作者：
da Costa, FDA;Dohmen, PM;Konertz, W
目的：比较Ross手术中用于RVOT重建的脱细胞与冷冻保存同种异体移植物的免疫学和超声心动图数据。方法：从2003年1月16日至2003年10月7日，使用脱细胞（n=11）或冷冻保存（n=9）同种异体移植物进行了20例Ross手术。在出院时、1、3、6和12个月以及此后每年进行超声心动图检查。在术前和术后第5、10、30、90和180天获得用于测定抗HLA I类和II类抗体的样品。在LAT-M培养皿（非特异性）中通过ELISA方法检测这些样品，以鉴定循环抗体，结果表示为平均样品值（Is= DO/临界值）。如果阳性，则进行LAT-E（特异性）并测定PRA水平。结果：无死亡病例。冷冻保存的同种异体移植物显示I类和II类抗体的Is值显著升高，其在第一个月开始并保持升高至6个月。相比之下，接受脱细胞同种异体移植的患者中，7例仍为阴性，2例I类抗体仅轻度升高，2例PRA水平异常升高。这种反应发生早于冷冻保存组，从术后第5天开始，在一个病例中已经恢复到基线水平。超声心动图显示，低温保存瓣膜的压差轻微但显著升高，但脱细胞瓣膜无压差升高。结论：脱细胞同种异体移植物在18个月内功能正常，与冷冻保存的瓣膜相比，免疫原性反应明显降低。(c)2005年由Elsevier B. V.出版
Objective: Compare the immunological and echocardiographic data of decellularized versus cryopreserved allografts used for RVOT reconstruction during Ross operation. Methods: From 16/01/03 thru 07/10/03, 20 Ross operations were performed using decellularized (n=11) or cryopreserved (n=9) allografts. Echocardiography was done at discharge, 1, 3, 6 and 12 months and annually thereafter. Samples for determination of antibodies against HLA class I and II were obtained preoperatively and at days 5, 10, 30, 90 and 180 postoperatively. These samples were tested by the ELISA method in LAT-M dishes (unspecific) for identification of circulating antibodies and the results expressed as mean sample values (Is= DO/cutoff). If positive, LAT-E (specific) was performed and PRA levels determined. Results: There was no mortality. Cryopreserved allografts showed marked Is values elevations for class I and II antibodies which started at the first month and remained elevated up to 6 months. In contrast, of the patients receiving decellularized allografts, seven remained negative, two patients had only marginal elevation of class I antibodies and two patients showed abnormal elevations of PRA levels. This response happened earlier than in the cryopreserved group, starting on the 5th postoperative day and has returned to baseline levels in one case. Echocardiography showed mild, but significant, elevation of gradients in cryopreserved valves but none in the decellularized. Conclusions: Decellularized allografts had normal function up to 18 months and showed important reduction of the immunogenic response when compared to cryopreserved valves. (c) 2005 Published by Elsevier B.V.