The Early and Midterm Function of Decellularized Aortic Valve Allografts
The Early and Midterm Function of Decellularized Aortic Valve Allografts
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DOI：
10.1016/j.athoracsur.2010.08.022
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发表时间：
2010-11-01
影响因子：
4.6
通讯作者：
Lopes, Sergio Veiga
中科院分区：
文献类型：
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作者：
da Costa, Francisco D. A.;Costa, Ana Claudia B. A.;Lopes, Sergio Veiga
背景本研究评价了脱细胞主动脉瓣同种异体移植物（DAVA）作为主动脉瓣置换术的早期和中期结果。2005年10月至2010年2月期间，41例患者（其中28例为男性，中位年龄为34岁（范围：0.1 - 71岁））接受了DAVA主动脉瓣置换术。用0.1%十二烷基硫酸钠溶液进行脱细胞。术后评价采用系列超声心动图、磁共振成像和多层计算机断层扫描研究，以评价瓣膜血流动力学、同种异体移植物管道尺寸和钙化评分。有3例早期死亡和1例晚期死亡，平均随访时间为19个月（范围，1至53）。有1例因二尖瓣修复失败而再次手术。所有患者的超声心动图显示，术后即刻峰值压差中位数为7 mm Hg（范围：1 - 26 mm Hg），末次随访时为4 mm Hg（范围：1 - 16 mm Hg）;除1例患者的瓣膜返流分级为轻度至中度外，所有患者的瓣膜返流分级为无或轻微。通过磁共振成像（n = 4），平均牙根尺寸在瓣环（24 mm）、主动脉窦（33 mm）和窦管交界处（28 mm）稳定。通过计算机断层扫描（n = 22），在3年随访时仅存在离散的导管钙化（中位钙评分63 Hounsfield单位[HU];范围，0至894 HU）。再次手术患者的导管活检显示壁结构保存良好，无钙化，体内宿主再生有限。DAVA的早期和中期结果证明了稳定的结构完整性、低钙化率和充分的血流动力学。虽然需要较长时间的观察，DAVA似乎是选定患者主动脉瓣置换术的一种有前途的替代方法。(Ann Thorac Surg 2010; 90：1854-61）（C）2010年，胸外科医师协会
Background. This study evaluates the early and midterm results of decellularized aortic valve allografts (DAVA) as an aortic valve replacement.Methods. Between October 2005 and February 2010, 41 patients, 28 of whom were male, with a median age of 34 years (range, 0.1 to 71), had aortic valve replacement with DAVA. Decellularization was obtained with a 0.1% sodium dodecyl sulfate solution. Postoperative evaluation was performed with serial echocardiograms, magnetic resonance imaging, and multislice computed tomography studies to evaluate valve hemodynamics, allograft conduit dimensions, and calcification scores.Results. There were 3 early deaths and 1 late death, with a mean follow-up of 19 months (range, 1 to 53). There was 1 reoperation due to a failed mitral valve repair. By echocardiography in all patients, the median immediate postoperative peak gradient was 7 mm Hg (range, 1 to 26 mm Hg), and at last follow-up it was 4 mm Hg (range, 1 to 16 mm Hg); valvular regurgitation was graded as none or trivial in all but 1 patient, who had a regurgitation graded as mild to moderate. By magnetic resonance imaging (n = 4), mean root dimensions were stable at the annulus (24 mm), sinus of Valsalva (33 mm), and sinotubular junction (28 mm). By computed tomography (n = 22), there was only discrete conduit calcification (median calcium score 63 Hounsfield units [HU]; range, 0 to 894 HU) to 3 years of follow-up. Conduit biopsy in the patient who underwent reoperation demonstrated well-preserved wall structure, absence of calcification, and limited in vivo host repopulation.Conclusions. The early and midterm results with DAVA demonstrated stable structural integrity, low rate of calcification, and adequate hemodynamics. Although longer periods of observation are necessary, DAVA appears to be a promising alternative for aortic valve replacement in selected patients. (Ann Thorac Surg 2010; 90: 1854-61) (C) 2010 by The Society of Thoracic Surgeons