Aortic valve replacement with autologous pericardium: long-term follow-up of 15 patients and in vivo histopathological changes of autologous pericardium
Aortic valve replacement with autologous pericardium: long-term follow-up of 15 patients and in vivo histopathological changes of autologous pericardium
复制标题
自体心包主动脉瓣置换术：15例患者长期随访及自体心包体内组织病理学变化
DOI：
10.1093/icvts/ivs441
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发表时间：
2013-02-01
影响因子：
--
通讯作者：
Xu, Zhiyun
中科院分区：
文献类型：
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作者：
Liu, Xiaohong;Han, Lin;Xu, Zhiyun
该研究旨在评估自体心包主动脉瓣（APAV）置换患者的长期随访，并分析植入APAV的体内组织病理学变化。从1996年到1997年，15名患者（平均年龄为34岁）接受了用戊二醛处理的自体心包进行主动脉瓣置换术。所有患者出院后均进行随访。切除的 APAV 进行苏木精-伊红、维多利亚蓝-范吉森染色和免疫组织化学染色。平均临床随访时间为 11.43 +/- 4.50 年。与 APAV 相关的院内死亡率和晚期死亡率均为 0%。 5 名 (33%) 患者因右冠状动脉尖脱垂 (n = 1)、感染性心内膜炎 (n = 1) 或纤维钙化变性 (n = 3) 需要再次手术。随访结束时，无心内膜炎、纤维钙化变性和再次手术的比例分别为 93%、80% 和 67%。其余 10 名患者均存活且状况良好，纽约心脏协会平均分级为 1.10 +/- 0.32，主动脉瓣功能正常（峰值压力梯度：7.70 +/- 3.41 mmHg；平均压力梯度：1.79 +/- 0.64 mmHg）。组织病理学显示 (i) 在所有非心内膜炎 APAV 上发现了薄的因子 VIII 阳性层（内皮化）； (ii) 所有 APAV 中的心包细胞均呈 α-平滑肌肌动蛋白阳性（肌成纤维细胞表型），纤维钙化 APAV 中的一些细胞呈碱性磷酸酶阳性（成骨细胞表型），并且 (iii) 在 3 例病例中发现松紧带（体内 > 9 年）。APAV 置换是一种死亡率较低的手术。 APAV 通过产生弹性带和内皮化来适应新的环境需求，而肌成纤维细胞/成骨细胞转分化似乎是 APAV 纤维钙化的原因。
The study aimed to assess the long-term follow-up of patients with an autologous pericardial aortic valve (APAV) replacement and to analyse in vivo histopathological changes in implanted APAVs.From 1996 to 1997, 15 patients (mean age, 34 years) underwent aortic valve replacement with the glutaraldehyde-treated autologous pericardium. All patients were followed up after discharge. The excised APAVs were processed for haematoxylin-eosin, Victoria blue-van Gieson and immunohistochemical staining.The mean clinical follow-up was 11.43 +/- 4.50 years. APAV-related in-hospital and late mortalities were both 0%. Five (33%) patients required reoperation because of a prolapse of the right coronary cusp (n = 1), infective endocarditis (n = 1) or fibrocalcific degeneration (n = 3). Freedom from endocarditis, fibrocalcific degeneration and reoperation at the end of follow-up was 93, 80 and 67%, respectively. The remaining 10 patients were alive and well with a mean New York Heart Association class of 1.10 +/- 0.32 and normally functioning aortic valves (peak pressure gradient: 7.70 +/- 3.41 mmHg; mean pressure gradient: 1.79 +/- 0.64 mmHg). Histopathology revealed that (i) a thin factor VIII-positive layer (endothelialization) was found on all non-endocarditis APAVs; (ii) pericardial cells in all APAVs were positive for alpha-smooth muscle actin (myofibroblast phenotype) and some cells in the fibrocalcific APAVs were positive for alkaline phosphatase (osteoblast phenotype) and (iii) an elastic band was found in 3 cases (in vivo > 9 years).APAV replacement is a procedure with a low mortality. APAVs adapt to new environmental demands by producing an elastic band and by endothelialization, whereas myofibroblast/osteoblast transdifferentiation seems to be responsible for the fibrocalcification of APAVs.