Ann Thorac Surg 1996;62:645
© 1996 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
D. Emerick Szilagyi, MD
Division of Vascular Surgery, Henry Ford Hospital, 2799 W Grand Blud, Detroit, MI 48202
See also page 640.
The recent revival of interest in the clinical use of arterial allografts is an intriguing phenomenon. As is, or should be, widely known, arterial allografts were the first substitutes used for resected diseased arteries from 1951 to 1955, but their use was discontinued because of their prohibitively frequent structural failure.
Yet, this generally highly disappointing early experience shed some rays of hope for possible success, a possibility that was almost universally overlooked. I choose as an illustration of this a survey conducted by my associates and me in May 1970 in patients with arterial allografts that had been in situ for 6 to 15 years. This study yielded the surprising finding that aortic allografts of high structural quality at the time of implantation have the potential to remain architecturally well preserved and functionally intact for as long as 15 years, and do so without the need for immunologic suppression.
The significance of this observation was for a long time overlooked, at least in part because of the advent of serviceable large-bore synthetic prostheses. The impressive clinical results of Vogt and associates should therefore not be particularly surprising, although the limit of the usefulness of aortic allografts in the management of infected prostheses has yet to be proved. As in all reconstructive surgical procedures, time is the judge of success. Vogt and associates do not supply a year-by-year breakdown of the follow-up in their patients and provide only the average and the range of the period of observation. The critical point of time in the follow-up in treating patients such as those described in this report would be around 5 years. Freedom from disease (ie, cure) up to 5 years is not proof of ultimate success but is a highly favorable index. The impression given in this report is that the median follow-up time was considerably less than 5 years.
Aside from this shortcoming, Vogt and associates have made a most impressive contribution and a highly encouraging start. I highly recommend that they continue the observation of their patients using all available appropriate means and periodically report their findings.
Related Article
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Eradication of Aortic Infections With the Use of Cryopreserved Arterial Homografts
- Paul R. Vogt, Ludwig K. von Segesser, Yves Goffin, Urs Niederhäuser, Michele Genoni, Andreas Künzli, Mario Lachat, and Marko I. Turina
Ann. Thorac. Surg. 1996 62: 640-645.
[Abstract]
[Full Text]
