The pulmonary homograft as aortic valve substitute: 7 years' follow up

• Published in: European journal of cardio-thoracic surgery 1997-05, Vol.11 (5), p.910-916
• Main Authors: MAIR, R, PESCHL, F, GROSS, C, KLIMA, U, HINTERREITER, H, BRUECKE, P
• Format: Article
• Language: English
• Subjects: Aortic Valve - surgery; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiology. Vascular system; Cryopreservation; Echocardiography, Doppler, Color; Endocardial and cardiac valvular diseases; Endocarditis, Bacterial - epidemiology; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Patient Selection; Postoperative Complications - epidemiology; Pulmonary Valve - transplantation; Time Factors; Transplantation, Homologous - adverse effects; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(97)01213-X

OBJECTIVE: The advantages of the aortic valve homograft high resistanceto infective endocarditis, low risk of thromboembolism, low gradient andexcellent long term results are well known. Trying to extend theseadvantages to a greater number of patients, we used pulmonary homografts asaortic valve substitute, based on the experimental evidence, that they canwithstand the higher stress in systemic circulation. METHODS: FromSeptember 1988 to August 1994 175 patients (103 men, 72 women, mean age61.75 +/- 12.92 years) underwent aortic valve replacement with acryopreserved pulmonary homograft. All valves were taken from our ownhomograft bank. They were inserted freehand intraaortically, 162 insubcoronary position, 13 as intraaortic cylinder. All patients werefollowed clinically and by colorflow Doppler echocardiography in 3-12 monthintervals. RESULTS: Patients, 8, died perioperatively (4.57%). None of thedeaths was valve related. Patients, 2, had to be reoperated during theperioperative period due to severe valvular incompetence 165 patients werefollowed up to a period of 7.5 years (mean interval 3.83 +/- 1.45 years).Patients, 30, died, 13 deaths (7.42%) must be regarded as valve related.Patients, 22, (12.52%) had to be reoperated due to severe graftincompetence. Patients, 9 (5.14%), acquired prosthetic endocarditis.CONCLUSION: Due to our results, high rate of valve related deaths, highrate of graft failure and high rate of prosthetic endocarditis, we muststate that the pulmonary homograft did not fulfil our expectations andpresently we can not recommend it as an aortic valve substitute.