Pulmonary Homografts for Aortic Valve Replacement: Long-term Comparison with Aortic Grafts

Authors

  • Ferdinand Vogt
  • Anke Kowert
  • Andres Beiras-Fernandez
  • Martin Oberhoffer
  • Ingo Kaczmarek
  • Bruno Reichart
  • Eckehard Kilian

DOI:

https://doi.org/10.1532/HSF98.20101162

Abstract

Objective: The use of homografts for aortic valve replacement (AVR) is an alternative to mechanical or biological valve prostheses, especially in younger patients. This retrospective comparative study evaluated our single-center long-term results, with a focus on the different origins of the homografts.

Methods: Since 1992, 366 adult patients have undergone AVR with homografts at our center. We compared 320 homografts of aortic origin and 46 homografts of pulmonary origin. The grafts were implanted via either a subcoronary technique or the root replacement technique. We performed a multivariate analysis to identify independent factors that influence survival. Freedom from reintervention and survival rates were calculated as cumulative events according to the Kaplan-Meier method, and differences were tested with the log-rank test.

Results: Overall mortality within 1 year was 6.5% (21/320) in the aortic graft group and 17.4% (8/46) in the pulmonary graft group. In the pulmonary graft group, 4 patients died from valve-related complications, 1 patient died after additional heterotopic heart transplantation, and 1 patient who entered with a primary higher risk died from a prosthesis infection. Two patients died from non-valve-related causes. During the long-term follow-up, the 15-year survival rate was 79.9% for patients in the aortic graft group and 68.7% for patients in the pulmonary graft group (P = .049). The rate of freedom from reoperation was 77.7% in the aortic graft group and 57.4% in the pulmonary graft group (P < .001). The reasons for homograft explantation were graft infections (aortic graft group, 5.0%; pulmonary graft group, 6.5%) and degeneration (aortic graft group, 7.5%; pulmonary graft group, 32.6%).

Conclusion: Our study demonstrated superior rates of survival and freedom from reintervention after AVR with aortic homografts. Implantation with a pulmonary graft was associated with a higher risk of redo surgery, owing to earlier degenerative alterations.

References

Barratt-Boyes BG, Roche AH, Brandt PW, Smith JC, Lowe JB. 1969. Aortic homograft valve replacement. A long-term follow-up of an initial series of 101 patient. Circulation 40:763-75.nBorger MA, Ivanov J, Armstrong S, Christie-Hrybinsky D, Feindel CM, David TE. 2006. Twenty-year results of the Hancock II bioprosthesis. J Heart Valve Dis 15:49-56.nButany J, Ahluwalia MS, Nair V, David TE. 2004. Cryopreserved pulmonary homograft: postimplant changes. Cardiovasc Pathol 13:59-61.nEdmunds LH Jr, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. 1996. Guidelines for reporting morbidity and mortality after cardiac valvular operations. The American Association for Thoracic Surgery, Ad Hoc Liaison Committees for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Ann Thorac Surg 62:932-5.nFischlein T, Schütz A, Haushofer M, et al. Immunologic reaction and viability of cryopreserved homografts. Ann Thorac Surg 1995;60:122-6.nFrater RW, Furlong P, Cosgrove DM, et al. 1998. Long-term durability and patient functional status of the Carpentier-Edwards Perimount pericardial bioprosthesis in the aortic position. J Heart Valve Dis 7:48-53.nGorczynski A, Trenkner M, Anisimowicz L, et al. 1982. Biomechanics of the pulmonary autograft valve in the aortic position. Thorax 37:535-9.nGulbins H, Kilian E, Roth S, Uhlig A, Kreuzer E, Reichart B. 2002. Is there an advantage in using homografts in patients with acute infective endocarditis of the aortic valve? J Heart Valve Dis 11:492-7.nHehrlein FW. 1971. Preservation problems of homologous and heterologous aortic valve grafts [in German]. Thoraxchir Vask Chir 19:394-5.nHörer J, Hanke T, Stierle U, et al. 2009. Homograft performance in children after the Ross operation. Ann Thorac Surg 88:609-15.nKilian E, Oberhoffer M, Gulbins H, Uhlig A, Kreuzer E, Reichart B. 2004. Ten years' experience in aortic valve replacement with homografts in 389 cases. J Heart Valve Dis 13:554-9.nLuk A, Butany J, Erlich SA, Henry J, David TE. 2007. Long-term morphological changes in a cryopreserved pulmonary valve homograft. Can J Cardiol 23:817-9.nLund O, Chandrasekaran V, Grocott-Mason R, et al. 1999. Primary aortic valve replacement with allografts over twenty-five years: valve-related and procedure-related determinants of outcome. J Thorac Cardiovasc Surg 117:77-90; discussion 90-1.nMair R, Harringer W, Wimmer-Greinecker G, et al. 1995. Aortic valve replacement with cryopreserved pulmonary allografts: five years' follow-up. Ann Thorac Surg 60:S185-8.nMirabet V, Carda C, Solves P, et al. 2008. Long-term storage in liquid nitrogen does not affect cell viability in cardiac valve allografts. Cryobiology 57:113-21.nNaegele H, Bohlmann M, Doring V, Kalmar P, Rodiger W. 2000. Results of aortic valve replacement with pulmonary and aortic homografts. J Heart Valve Dis 9:215-20; discussion 220-1.nNiwaya K, Elkins RC, Knott-Craig CJ, et al. 1999. Advantage of autograft and homograft valve replacement for complex aortic valve endocarditis. Ann Thorac Surg 67:1603-8.nO'Brien MF, Harrocks S, Stafford EG, et al. 2001. The homograft aortic valve: a 29-year, 99.3% follow up of 1,022 valve replacements. J Heart Valve Dis 10:334-44; discussion 335.nO'Brien MF, Stafford EG, Gardner M, et al. 1987. The viable cryopreserved allograft aortic valve. J Card Surg 2(suppl):153-67.nRiberi A, Caus T, Mesana T, et al. 1997. Aortic valve or root replacement with cryopreserved homograft for active infectious endocarditis. Cardiovasc Surg 5:579-83.nRoss DN. 1962. Homograft replacement of the aortic valve. Lancet 2:487-93.nSchütz A, Fischlein T, Haushofer M, et al. 1993. Homograft aus der eigenen Herzklappenbank. Z Transplantationsmedizin 5:194.nTweddell JS, Pelech AN, Frommelt PC, et al. 2000. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation 102(suppl 3):III130-5.nYacoub M, Kittle F. 1970. Sterilization of homografts by antibiotic solutions. Circulation 41(suppl):II29-32.nYacoub M, Nasser RH, Lund O, et al. 1995. Fourteen-year experience with homovital homografts for aortic valve replacement. J Thorac Cardiovasc Surg 110:186-93.n

Published

2011-08-22

How to Cite

Vogt, F., Kowert, A., Beiras-Fernandez, A., Oberhoffer, M., Kaczmarek, I., Reichart, B., & Kilian, E. (2011). Pulmonary Homografts for Aortic Valve Replacement: Long-term Comparison with Aortic Grafts. The Heart Surgery Forum, 14(4), E237-E241. https://doi.org/10.1532/HSF98.20101162

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