Cryopreserved homograft valves in the pulmonary position: Risk analysis for intermediate-term failure
| Autor: | Mary M. Lane, K. Chandrasekaren, Christopher J. Knott-Craig, Edward D. Overholt, Ronald C. Elkins, Kazuo Niwaya |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
Heart Defects Congenital Male Reoperation Pulmonary and Respiratory Medicine medicine.medical_specialty Adolescent Pulmonary insufficiency Risk Assessment Truncus arteriosus Cryopreservation medicine Humans Transplantation Homologous Risk factor Child Tetralogy of Fallot Intermediate term Pulmonary Valve business.industry Infant Newborn Infant Middle Aged medicine.disease Prosthesis Failure Surgery body regions Transplantation surgical procedures operative medicine.anatomical_structure Aortic Valve Child Preschool Pulmonary valve Multivariate Analysis Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 117:141-147 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/s0022-5223(99)70479-4 |
| Popis: | Objective: The purpose of this study was to examine the durability of cryopreserved homografts used to replace the “pulmonary” valve and to identify factors associated with their late deterioration. Methods: We reviewed our entire experience (1985-1997) with 331 survivors in whom cryopreserved homograft valves (pulmonary, n = 304; aortic, n = 27) were used to reconstruct the pulmonary outflow tract. Median age was 14 years (range, 2 days–62 years). Operations included Ross operation (n = 259), tetralogy of Fallot (n = 41), truncus arteriosus (n = 14), Rastelli operation (n = 11), and others (n = 6). Median follow-up was 3.8 years (range, 0.2–11.2 years); late echographic follow-up was complete for 97% of patients. Homograft failure was defined as the need for explantation and valve-related death; homograft dysfunction was defined as a pulmonary insufficiency grade 3/4 or greater and a transvalvular gradient of 40 mm Hg or greater. Results: Homograft failure occurred in 9% (30 of 331 patients; Kaplan-Meier); freedom from failure was 82% ± 4% at 8 years. Homograft dysfunction occurred in 12% (39 of 331 patients), although freedom from dysfunction was 76% ± 4% at 8 years. For aortic homografts, this was 56% ± 11%, compared to 80% ± 4% for pulmonary homografts ( P = .003). For patients aged less than 3 years (n = 38), this was 51% ± 12%, compared with 87% ± 4% for older patients ( P = .0001). By multivariable analysis, younger age of homograft donors, non-Ross operation, and later year of operation were associated with homograft failure; younger age of homograft donors, later year of operation, and use of an aortic homograft were associated with homograft dysfunction. Conclusions: Homograft valves function satisfactorily in the pulmonary position at mid-term follow-up. The pulmonary homograft valve appears to be more durable than the aortic homograft valve in the pulmonary position. (J Thorac Cardiovasc Surg 1999;117:141-7) |
| Databáze: | OpenAIRE |
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