Aortic Homograft: A Suitable Substitute for Aortic Valve Replacement

Talwar, Sachin; Mohapatra, Raghunath; Saxena, Anitá; Singh, Rajvir; Kumar, Arkalgud Sampath

doi:10.1016/j.athoracsur.2005.03.056

Cited by 20 publications

(13 citation statements)

References 25 publications

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“…Indeed, three relatively recent studies in this review, where the indication for surgery was endocarditis in more than 40% of the patients, reported relatively low late mortality rates [ 23 – 25 ]. Furthermore, the low mean age of two studies with a high proportion of concomitant procedures [ 33 , 34 ] might explain why studies with a high proportion of concomitant procedures report lower late mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Contemporary outcomes after surgical aortic valve replacement with bioprostheses and allografts: a systematic review and meta-analysis

Huygens

Mokhles

Hanif

et al. 2016

Eur J Cardiothorac Surg

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Many observational studies have reported outcomes after surgical aortic valve replacement (AVR), but there are no recent systematic reviews and meta-analyses including all available bioprostheses and allografts. The objective of this study is to provide a comprehensive and up-to-date overview of the outcomes after AVR with bioprostheses and allografts reported in the last 15 years. We conducted a systematic literature review (PROSPERO register: CRD42015017041) of studies published between 2000–15. Inclusion criteria were observational studies or randomized controlled trials reporting on outcomes of AVR with bioprostheses (stented or stentless) or allografts, with or without coronary artery bypass grafting (CABG) or valve repair procedure, with study population size n ≥ 30 and mean follow-up length ≥5 years. Fifty-four bioprosthesis studies and 14 allograft studies were included, encompassing 55 712 and 3872 patients and 349 840 and 32 419 patient-years, respectively. We pooled early mortality risk and linearized occurrence rates of valve-related events, reintervention and late mortality in a random-effects model. Sensitivity, meta-regression and subgroup analyses were performed to investigate the influence of outliers on the pooled estimates and to explore sources of heterogeneity. Funnel plots were used to investigate publication bias. Pooled early mortality risks for bioprostheses and allografts were 4.99% (95% confidence interval [CI], 4.44–5.62) and 5.03% (95% CI, 3.61–7.01), respectively. The late mortality rate was 5.70%/patient-year (95% CI, 4.99–5.62) for bioprostheses and 1.68%/patient-year (95% CI, 1.23–2.28) for allografts. Pooled reintervention rates for bioprostheses and allografts were 0.75%/patient-year (95% CI, 0.61–0.91) and 1.87%/patient-year (95% CI, 1.52–2.31), respectively. There was substantial heterogeneity in most outcomes. Meta-regression analyses identified covariates that could explain the heterogeneity: implantation period, valve type, patient age, gender, pre-intervention New York Heart Association class III/IV, concomitant CABG, study design and follow-up length. There is possible publication bias in all outcomes. This comprehensive systematic review and meta-analysis provides an overview of the outcomes after AVR with bioprostheses and allografts reported during the last 15 years. The results of this study can support patients and doctors in the prosthetic valve choice and can be used in microsimulation models to predict patient outcomes and estimate the cost-effectiveness of AVR with bioprostheses or allografts compared with current and future heart valve prostheses.

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Section: Discussionmentioning

confidence: 99%

Contemporary outcomes after surgical aortic valve replacement with bioprostheses and allografts: a systematic review and meta-analysis

Huygens

Mokhles

Hanif

et al. 2016

Eur J Cardiothorac Surg

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“…Results of HAVR had shown actuarial and reoperation-free survival at a median follow-up of 68.5 months to be 92.2 ± 2.2% and 95.8 ± 1.9%, respectively while freedom from significant aortic stenosis or regurgitation was 86.1 ±3.2% 19 . On the other hand Ross procedure is not an ideal option in the young rheumatics as demonstrated by us earlier 20 , however; actuarial survival of Ross operation had been One patient died after 6 months of surgery due to development of endocarditis/para-valvular abscess in aortic root with complete heart block and sepsis.…”

Section: Discussionmentioning

confidence: 99%

Early results of aortic valve reconstruction with stentless glutaraldehyde treated autologous pericardial valve

Mittal

Talwar

Devagourou

et al. 2009

Indian J Thorac Cardiovasc Surg

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“…Many centers do not have experience with these grafts and hence technical mistakes are often made in the hands of inexperienced surgeons during operations. However, once the valve banks are established and the technical skills are improved, the procedure is highly favorable and cost effective (21).…”

Section: Discussionmentioning

confidence: 99%

Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

et al. 2012

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Objective: The aim of this study was to analyze the midterm clinical results of aortic valve replacement with cryopreserved homografts.Materials and Methods: Aortic valve replacement was performed in 40 patients with cryopreserved homograft. The indications were aortic valve endocarditis in 20 patients (50%), truncus arteriosus in 6 patients (15%), and re-stenosis or regurtitation after aortic valve reconstruction in 14 (35%) patients. The valve sizes ranged from 10 to 27mm. A full root replacement technique was used for homograft replacement in all patients.Results: The 30-day postoperative mortality rate was 12.5% (5 patients). There were four late deaths. Only one of them was related to cardiac events. Overall mortality was 22.5%. Thirty-three patients were followed up for 67±26 months. Two patients needed reoperation due to aortic aneurysm caused by endocarditis. The mean transvalvular gradient significantly decreased after valve replacement (p<0.003). The last follow up showed that the 27 (82%) patients had a normal left ventricular function. Conclusion:Cryopreserved homografts are safe alternatives to mechanical valves that can be used when there are proper indications. Although it has a high perioperative mortality rate, cryopreserved homograft implantation is an alternative for valve replacement, particularly in younger patients and for complex surgical problems such as endocarditis that must be minimalized.

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Aortic Homograft: A Suitable Substitute for Aortic Valve Replacement

Cited by 20 publications

References 25 publications

Contemporary outcomes after surgical aortic valve replacement with bioprostheses and allografts: a systematic review and meta-analysis

Contemporary outcomes after surgical aortic valve replacement with bioprostheses and allografts: a systematic review and meta-analysis

Early results of aortic valve reconstruction with stentless glutaraldehyde treated autologous pericardial valve

Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

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