Fourteen-year experience with homovital homografts for aortic valve replacement

Abstract

Two hundred seventy-five unprocessed, viable homograft ("homovital") aortic valves were used for aortic valve replacement in patients aged 1.5 to 79 years (mean 45.8 +/- 19 years) with maximum follow-up of a 14-year period (mean 4.8 years). Ninety-two percent (252 patients) had New York Heart Association class III or IV functional status before operation and 25 underwent emergency operation. Valves were harvested under sterile conditions and kept in nutrient medium 199. Freehand (subcoronary) technique was used in 147 patients and freestanding root replacement was used in 128. Cumulative survival rates for the whole group were 92% +/- 2% at 5 years and 85% +/- 3% at 10 years, as compared with 96% +/- 2% and 94% +/- 4%, respectively, for the 98 patients who underwent isolated root replacement. Multivariate analysis determined that root replacement with associated procedures and operation for prosthetic endocarditis were risk factors for death, whereas previous xenograft valve, operation for endocarditis, and operation for aortic regurgitation were risk factors for reoperation. Actuarial rates for freedom from degenerative valve failure diagnosed at operation, by postmortem examination, or by routine echocardiography were 94% +/- 2% at 5 years and 89% +/- 3% at 10 years. Recipient age younger than 30 years and previous xenograft valve were risk factors for late degeneration. We conclude that homovital valves demonstrate good durability, particularly in patients older than 30 years, who had a 10-year freedom from degeneration rate of 97%.

Estudo experimental comparativo do enxerto homólogo pulmonar tratado pelo processo L-Hydro com o homoenxerto pulmonar a fresco

“…In our study, we compared the L-Hydro group with a control group of "in fresh" homografts with the immediate use, real "homovital" grafts. We proceeded like this in order to have a reference comparison with the "gold standard" of the grafts, once the published clinical studies using "homovital" grafts show exceptional results, reaching up to 97% of the grafts free of degeneration in 10 years [22]. In the series of Yacoub, the clinical use of "homovital" homografts was an independent factor for reduced mortality [22].…”

“…We proceeded like this in order to have a reference comparison with the "gold standard" of the grafts, once the published clinical studies using "homovital" grafts show exceptional results, reaching up to 97% of the grafts free of degeneration in 10 years [22]. In the series of Yacoub, the clinical use of "homovital" homografts was an independent factor for reduced mortality [22]. It is known that any processing of grafts, including sterilization with low concentration of antibiotics has the potential to alter the viability as well as the physical and antigenic properties of the tissue [23].…”

<![CDATA[<B>Ten years experience of aortic valve replacement with aortic homograft root replacement</B>]]>

“…Other studies confirmed this observation. Yacoub et al [15] reported their 14-year experience using "homovital" homografts and demonstrated that 89% were free from dysfunction at 10 years of evolution. According to these authors an estimated 73% would be free of dysfunction after 10 years of follow-up for a 15-year-old patient at the time of implant and 97% for a 70-year-old patient.…”

Which Valve to Who: Prosthetic Valve Selection for Aortic Valve Surgery

“…Homografts can be an alternative for the young women at childbearing age. There is no evident data about the possible complications of this valve not needing an anticoagulation and its generation during pregnancy (Yacoub, 1995;Waszyrowski, 1997). However, some studies in the literature gave an idea.…”