A comparison of aortic valve replacement with viable cryopreserved and fresh allograft valves, with a note on chromosomal studies.
A comparison of aortic valve replacement with viable cryopreserved and fresh allograft valves, with a note on chromosomal studies.
复制标题
主动脉瓣置换术与可行的冷冻保存和新鲜同种异体移植瓣膜的比较，并附有染色体研究的注释。
DOI：
10.1016/s0022-5223(19)36152-5
复制
发表时间：
1987
期刊：
影响因子：
--
通讯作者：
D. McGiffin
中科院分区：
文献类型：
--
作者：
M. O’Brien;E. G. Stafford;M. Gardner;P. Pohlner;D. McGiffin
我们检查了同种异体主动脉瓣的长期临床功能和命运，通过两种不同的方法保存，用于主动脉瓣置换术：（1）新鲜同种异体移植物在4° C冷藏（I组）和（2）在-196° C液氮中冷冻保存的存活同种异体移植物（II组）。共进行了316例主动脉瓣置换术，I组124例（1969年12月至1975年5月），II组192例（1975年6月至1986年12月）。在120例手术中，需要同时进行外科手术（例如，冠状动脉旁路移植术和二尖瓣置换术）。30天内总体死亡率为6.0%（置信限4.6%至7.7%），4年生存率为83%，15年生存率为60%。根据参数估计和风险函数分析，两组之间的心内膜炎和有关再次手术的技术因素没有差异。然而，瓣膜退变的再次手术存在显著差异：I组23例患者，II组0例患者。10年时，I组和II组的瓣膜退变再手术率分别为89%和100%，15年时，I组为59%。I组的风险函数反映了后期退化风险的上升。两组（主动脉瓣置换伴或不伴旁路移植术）的无血栓栓塞率在10年时为97%，在15年时为96%。组织培养、代谢研究和组织学外观均显示II组瓣膜（因技术性对线不良原因而手术）具有持续存活能力。染色体研究表明这些细胞的供体来源。冷冻保存瓣膜的上级结果被认为是由于持续的活力，这似乎是耐久性的关键。
We examined the long-term clinical function and fate of allograft aortic valves, preserved by two differing methods, for aortic valve replacement: (1) fresh allografts stored at 4° C refrigeration (group I) and (2) viable allografts cryopreserved in liquid nitrogen at –196° C (group II). A total of 316 aortic valve replacement operations were performed, 124 in group I (December 1969 to May 1975) and 192 in group II (June 1975 to December 1986). Concomitant surgical procedures (eg, coronary artery bypass grafting and mitral valve replacement) were necessary in 120 operations. The overall immediate 30 day mortality was 6.0% (confident limits 4.6% to 7.7%), and the survival rates were 83% at 4 years and 60% at 15 years. Endocarditis and technical factors concerning reoperation showed no difference between the two groups according to parametric estimates and hazard function analyses. However, there was a marked difference in reoperation for valve degeneration: 23 patients in group I and 0 patients in group II. The freedom from reoperation for valve degeneration at 10 years was 89% for group I and 100% for group II, and at 15 years it was 59% for group I. The hazard function for group I reflected the late rising risk of degeneration. The freedom from thromboembolism of both groups (aortic valve replacement with or without bypass grafting) was 97% at 10 years and 96% at 15 years. Group II explanted valves (operation for technical malalignment reasons) has consistently shown evidence of persisting viability on tissue culture, on metabolic studies, and on histologic appearances. Chromosomal studies have shown the donor origin of these cells. The superior results with the cryopreserved valve is considered to be due to persisting viability, which appears to be the key to durability.