Hemodynamic performance at rest and during exercise after aortic valve replacement: comparison of pulmonary autografts vs. aortic homografts

Laforest, Isabelle; Dumesnil, Jean G.; Briand, Martin; Cartier, P

doi:10.1016/s1062-1458(02)01067-x

Cited by 17 publications

(21 citation statements)

References 20 publications

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“…Various authors consider aortic homografts as an ideal substitute for aortic replacement in young patients because of their superior hemodynamic performance, the absence of anticoagulation treatment and their low infection rate [8,9]. The obvious drawbacks are their limited availability and a complicated implantation operative technique.…”

Section: Discussionmentioning

confidence: 99%

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Redo aortic root surgery for failure of an aortic homograft is a major technical challenge☆

Joudinaud

Baron

Raffoul

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective: Aortic homografts offer many advantages over prosthetic valves. However, homograft dysfunction due to degeneration or infection may lead to reoperation. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge. To assess reoperation events a retrospective review was conducted. Materials and methods: From January 2000 to October 2006, 20 consecutive patients (38.8 AE 14.9 years old) underwent repeat surgery for aortic homograft failure. Results: Reoperation was performed 7.2 AE 3.5 years after implantation of the aortic homograft as a root. Indication was homograft degeneration (n = 18 [90%]) and endocarditis (n = 2 [10%]). In patients with major homograft wall calcifications or endocarditis, nine aortic root reconstructions were performed (Bentall procedure n = 7; homograft implantation n = 2). Each homograft was dissected with electrical cauterization and removed 'en-bloc' sparing the coronary buttons. In case of flexible homograft wall, stented prostheses (mechanical n = 10, bioprosthesis n = 1) were implanted along the homograft annulus. Additional procedures consisted of mitral valve replacements (n = 8), tricuspid repairs (n = 4), Konno procedure (n = 1) and coronary bypass (n = 5). Perioperative complications occurred in seven (35%) patients: sternal re-entry accident (n = 2); reoperations for mediastinitis (n = 1) or bleeding (n = 2); renal insufficiency (n = 1); total heart block (n = 1). No association was found between operative procedures and postoperative complications (Fisher's exact test). Two patients (10%) died from multiorgan failure in the early postoperative period. In total, 94.4% of the survivors remained free from reoperation at 74 months. Conclusion: Reoperation on patients with an aortic homograft as a root presents a relatively high perioperative morbidity. The surgical strategy depends on the degree of homograft wall calcification. #

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Section: Discussionmentioning

confidence: 99%

“…In case of major calcifications and a rigid wall of the homograft, the surgeon has to perform a root replacement (e.g. BentallDeBono procedure) [8,13,18]. We applied this strategy in seven patients who presented major calcifications of the root.…”

Section: Discussionmentioning

confidence: 99%

Redo aortic root surgery for failure of an aortic homograft is a major technical challenge☆

Joudinaud

Baron

Raffoul

et al. 2008

European Journal of Cardio-Thoracic Surgery

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show abstract

“…Pulmonary valve and trunk stenosis of the pulmonary homograft in patients undergoing the Ross procedure has been a particularly difficult problem, seen in up to 20% of patients in some series. 377 Postoperative conduit stenosis and regurgitation are also major issues for patients with tetralogy of Fallot.…”

Section: Definitionmentioning

confidence: 99%

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

Warnes¹,

Williams²,

Bashore³

et al. 2008

Circulation

892

365

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“…862 Small, short-term randomized and nonrandomized comparisons of pulmonary autografts and aortic homografts have demonstrated no definite advantage of either in adults in terms of hemodynamics and patient outcome. [905][906][907] Deterioration of the pulmonary homograft also offsets potential advantages of the autograft.…”

Section: Pulmonic Valve Autotransplantationmentioning

confidence: 99%

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Bonow¹,

Carabello²,

Chatterjee³

et al. 2008

Circulation

916

259

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Hemodynamic performance at rest and during exercise after aortic valve replacement: comparison of pulmonary autografts vs. aortic homografts

Cited by 17 publications

References 20 publications

Redo aortic root surgery for failure of an aortic homograft is a major technical challenge☆

Redo aortic root surgery for failure of an aortic homograft is a major technical challenge☆

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

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