脱细胞肺异种移植基质 PplusN 与低温保存的同种移植物在成人 Ross 手术中用于 RVOT 重建的比较

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Thoracic and Cardiovascular Surgeon Pub Date : 2024-04-01 Epub Date: 2021-12-31 DOI:10.1055/s-0041-1740539
Kiril Penov, Matz Andreas Haugen, Dejan Radakovic, Khaled Hamouda, Armin Gorski, Rainer Leyh, Constanze Bening
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引用次数: 0

摘要

背景:在接受罗斯手术的成年患者中,脱细胞肺同种异体移植物越来越多地被用于右心室流出道重建。很少有报道对 Matrix PplusN 异种移植(Matrix)进行负面评价。本研究的目的是比较 Matrix 异种移植与标准低温保存肺动脉同种移植(CPHG)的中期疗效:2012年1月至2016年6月期间,18名患者接受了Matrix异种移植,66名患者接受了CPHG。通过非参数统计检验和生存分析,我们比较了两组患者的中期超声心动图和临床结果:除了年龄有明显差异(Matrix 组年龄为 57 ± 8 岁,明显大于 CPHG 组的 48 ± 9 岁,P = 0.02),两组患者的其他基线特征相似。Matrix 组和 CPHG 组的心肺旁路时间(208.3 ± 32.1 对 202.8 ± 34.8)和交叉钳夹时间(174 ± 33.9 对 184.4 ± 31.1)分别没有明显差异。Matrix 组的再介入自由度(77.8% 对 98.5%)明显低于 CPHG 组(p = 0.02)。Matrix组和CPHG组的肺动脉瓣反流自由度≥2没有明显差异,分别为82.4%和90.5%。中位随访4.9年后,Matrix异种移植的峰值压力梯度明显高于CPHG(20.4 ± 15.5 vs. 12.2 ± 9.0 mm Hg; p = 0.04):经过5年的临床和超声心动图随访,与标准CPHG相比,脱细胞Matrix异种移植的再介入自由度较低。有必要进行更密切的随访,以避免瓣膜功能衰竭发展为右心室恶化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Decellularized Pulmonary Xenograft Matrix PplusN versus Cryopreserved Homograft for RVOT Reconstruction during Ross Procedure in Adults.

Background:  Decellularized pulmonary homografts are being increasingly adopted for right ventricular outflow tract reconstruction in adult patients undergoing the Ross procedure. Few reports presented Matrix PplusN xenograft (Matrix) in a negative light. The objective of this study was to compare our midterm outcomes of Matrix xenograft versus standard cryopreserved pulmonary homograft (CPHG).

Methods:  Eighteen patients received Matrix xenograft between January 2012 and June 2016, whereas 66 patients received CPHG. Using nonparametric statistical tests and survival analysis, we compared midterm echocardiographic and clinical outcomes between the groups.

Results:  Except for significant age difference (the Matrix group was significantly older with 57 ± 8 years than the CPHG group, 48 ± 9 years, p = 0.02), the groups were similar in all other baseline characteristics. There were no significant differences in cardiopulmonary bypass times (208.3 ± 32.1 vs. 202.8 ± 34.8) or in cross-clamp times (174 ± 33.9 vs. 184.4 ± 31.1) for Matrix and CPHG, respectively. The Matrix group had significantly inferior freedom from reintervention than the CPHG group with 77.8 versus 98.5% (p = 0.02). Freedom from pulmonary valve regurgitation ≥ 2 was not significantly different between the groups with 82.4 versus 90.5% for Matrix versus CPHG, respectively. After median follow-up of 4.9 years, Matrix xenograft developed significantly higher peak pressure gradients compared with CPHG (20.4 ± 15.5 vs. 12.2 ± 9.0 mm Hg; p = 0.04).

Conclusion:  After 5 years of clinical and echocardiographic follow-up, the decellularized Matrix xenograft had inferior freedom from reintervention compared with the standard CPHG. Closer follow-up is necessary to avoid progression of valve failure into right ventricular deterioration.

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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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