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OBJETIVO: Buscando novas formas de preservação de tecidos utilizamos o polietileno-glicol, método L-Hydro (LH), que consiste na extração controlada de substâncias antigênicas e incorporação de agente antinflamatório e antitrombótico. MÉTODOS: Em dez carneiros jovens, substituímos o tronco pulmonar, em sete, por homoenxertos pulmonares (HP) tratados pelo processo L-H e, em três, por HP a fresco, implantados ortotopicamente, seguidos por 320 dias. Os carneiros foram avaliados por exames laboratoriais e ecocardiográficos. Ao cabo dos 320 dias foram sacrificados, procedendo-se à avaliação hemodinâmica, radiológica, macro/microscópica, óptica e eletrônica, varredura e transmissão. Resultados foram analisados pelo teste t de Student de amostras independentes para dados contínuos, análise de variância para medidas repetidas, pelo teste exato de Fisher para dados categóricos. RESULTADOS: Evolução clínica e exames laboratoriais não conseguiram estabelecer diferenças significativas entre os grupos. Ecocardiograma revelou diferença quanto ao gradiente médio pulmonar, significativa aos 10 meses, maior no grupo controle. Avaliação radiológica e macroscópica não estabeleceu diferenças. Na avaliação microscópica, óptica/eletrônica, células de revestimento e intersticiais foram encontradas nos dois grupos igualmente. O porcentual de revestimento celular calculado nos dois grupos foi semelhante. Nódulos de celularidade foram observados somente no grupo de homoenxertos a fresco. CONCLUSÕES: Estes dados indicam que os dois grupos apresentaram desempenho clínico e hemodinâmico semelhante. Ao ecocardiograma o grupo LH apresentou melhor desempenho, e evidências histológicas de repopulação celular intersticial e endotelial. Na análise macro/microscópica, óptica/eletrônica, o grupo L-Hydro apresentou macroscopia, estrutura histológica e ultraestrutural semelhante ao homoenxerto fresco, à exceção de nódulos de maior celularidade intersticial, presentes apenas no homoenxerto a fresco. OBJECTIVE: In an effort to make available homografts preserved in a simpler and less costly way, we evaluated the polyethyleneglycol, L-Hydro (LH) method, that consists in the controlled extraction of antigenic substances and the incorporation of anti-inflammatory and anti-thrombotic agent. METHODS: We substituted the pulmonary trunk in ten ovines, seven received LH treated pulmonary homografts and three, fresh pulmonary homografts, orthotopically implanted and followed-up for 320 days. Ovines where evaluated by means of laboratory tests, echocardiographic exams. At the 320 days, were euthanized, hemodynamic, radiology, macroscopic, optic/electronic microscopic, scanning/transmission evaluations were performed. Results were analyzed by Student t test of independent samples for continuous data, by variance analysis of repeated measures, and by Fisher exact test for categorical data. RESULTS: We couldn't establish relevant differences in clinical evolution and laboratory tests between groups. Echocardiogram revealed difference in pulmonary medium gradient, which was significant 10 months follow-up, higher in the control group. Radiologic and macroscopic evaluations didn't established differences. In the optic/electronic microscopic evaluation, liner and interstitial cells were equally found in both groups. The cell liner percent calculated in both groups was similar. Cellularity nodules were observed only infresh homograft group. CONCLUSIONS: These data indicate that both groups presented similar clinical/hemodynamic performances. The LH group's echocardiogram presented a better performance. It also presented histological evidences of interstitial and endothelial cell repopulation. In the macro/optic and electronic microscopic analysis, group L-H presented macroscopy/histological structure and ultra-structural similar to the fresh group, with the exception of nodules with higher interstitial cellularity, present only in the fresh homograft group.

In an effort to make available homografts preserved in a simpler and less costly way, we evaluated the polyethyleneglycol, L-Hydro (LH) method, that consists in the controlled extraction of antigenic substances and the incorporation of anti-inflammatory and anti-thrombotic agent.We substituted the pulmonary trunk in ten ovines, seven received LH treated pulmonary homografts and three, fresh pulmonary homografts, orthotopically implanted and followed-up for 320 days. Ovines where evaluated by means of laboratory tests, echocardiographic exams. At the 320 days, were euthanized, hemodynamic, radiology, macroscopic, optic/electronic microscopic, scanning/transmission evaluations were performed. Results were analyzed by Student t test of independent samples for continuous data, by variance analysis of repeated measures, and by Fisher exact test for categorical data.We couldn't establish relevant differences in clinical evolution and laboratory tests between groups. Echocardiogram revealed difference in pulmonary medium gradient, which was significant 10 months follow-up, higher in the control group. Radiologic and macroscopic evaluations didn't established differences. In the optic/electronic microscopic evaluation, liner and interstitial cells were equally found in both groups. The cell liner percent calculated in both groups was similar. Cellularity nodules were observed only infresh homograft group.These data indicate that both groups presented similar clinical/hemodynamic performances. The LH group's echocardiogram presented a better performance. It also presented histological evidences of interstitial and endothelial cell repopulation. In the macro/optic and electronic microscopic analysis, group L-H presented macroscopy/histological structure and ultra-structural similar to the fresh group, with the exception of nodules with higher interstitial cellularity, present only in the fresh homograft group.

Para avaliar o valor prognóstico da fração de ejeção do ventrículo esquerdo, entre 210 pacientes com lesões da valva aórtica operados, consecutivamente, entre maio de 1981 e outubro de 1988 e que receberam as próteses Omniscience e Meditronic-Hall, foram selecionados 112 e divididos, de acordo com a fração de ejeção do ventrículo esquerdo, em dois grupos: o G1 = FE > 40%, ficou com 52 pacientes com médias de idade 39 ± 12 anos, FE = 58 ± 10% e classe funcional (NYHA) = 2,8; o GE = FE < 40% ficou com 60 pacientes com médias de idade 48 ± 17 anos, FE = 27 ± 13% e (NYHA) = 3,6. Nas cirurgias, foram utilizados hipotermia e hemodiluição moderadas, oxigenador de bolhas, infusão cardioplégica St. Thomas. As médias dos tempos de circulação extracorpórea e parada cardíaca foram: no G1 =8 2 ± 18 e 49 ±7 minutos, e 96 ± 11 e 55 ± 6 minutos, no Grupo 2; o tamanho das próteses foi 25,2 ± 1,8 milímetros. No Grupo 1, a mortalidade imediata foi 3,8% no G1 e 5,8 no G2, e a tardia 4% no G1, e no G2 foi 8,7%. No G1 houve significante associação entre a mortalidade e a função ventricular sistólica. Clínicamente, no G1, 65% dos pacientes estão na (NYHA) I, 28% na II, 5% na III e 2% na IV. No G2, 46% estão na (NYHA) I, 25% na II, 13% na III, e 16% na IV. A sobrevida atuarial em sete anos foi 88 ± 2% no G1 e 76 ± 4% no G2. Portanto, os pacientes com FE < 40% apresentaram mortalidade mais elevada, menor sobrevida a curto e longo prazo e resultados clínicos menos satisfatórios. Para obtermos melhores resultados, devemos operar antes que a FE em repouso e exercício se torne deprimida, ou que apareça intolerância ao exercício moderado. To evaluate the prognostic value of resting left ventricular ejection fraction (LVEF) a series of 210 consecutive patients with aortic valve disease operated upon between May 1981 and October 1988 was studied retrospectively. All patients had their aortic valve replaced by Omniscience or Meditronic prosthesis; 112 formed the study group because they have complete follow up and cineangiocardiographic data. Based on pre-operatory left ventricular ejection fraction the patients were divided in two groups: Group 1 = 52 patients with LVEF > 40%, 39 ± 12 years, NYHA functional class 2.8, and EF 58 ± 10%. Group 2 = 60 patients with LVEF < 40, 48 ± 17 years, NYHA functional class 3.6, and LVEF of 27 ± 12%. During surgery moderate hypothermia and hemodilution were utilized, with dubble oxygenator and cardioplegia With St. Thomas cardioplegic solution. Mean extracorporeal circulation and cardiac arrest time were respectively 82 ± 18 and 49 ± 7 minutes in Group 1 and 96 ± 11 and 55 ± 6 minutes in Group 2. The size of the prosthesis were 25.2 ± 1.8 mm in Group 1. The short term mortality was 3.8% in Group 1 and 5.8 in Group 2. The long-term mortality was 4.0% in Group 1 and 8.7% in Group 2. In Group 1 there was a significant association between mortality and left ventricular systolic function. In the follow-up evaluation, among patients in Group 1, 65% were in class I, 28% were in functional class II, 5% in class III, and 2% in class IV. Among patients in group II 46% were in class I, 25% in class II, 13% in class III, and 16% in class IV. The 7 year survival rate was 88 ± 2% in Group 1 and 76 ± 4% in Group 2. Thus, patients with LVEF less than 40% had higher short and longterm mortality and worse clinical course. For better surgical results patients with aortic valve disease should be operated upon before the reduction of left ventricular systolic function.