Human Tissue Valves in Aortic Position

Willems, Tineke P.; Takkenberg, Johanna J.M.; Kleyburg-Linkers, Veronica E.; Roelandt, Jos R.T.C.; Bos, Egbert; Herwerden, Lex A. van

doi:10.1161/01.cir.103.11.1515

Cited by 36 publications

(2 citation statements)

References 21 publications

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“…This root replacement technique (RRT) decreases the risks of geometrical distortion due to technical error since the homograft is implanted as a functional unit. The sub coronary technique (ST) carries the advantage of an easier reoperation in the event of structural deterioration as compared to the RRT (24). However, the technique is difficult, has a learning curve, and the technique itself has a higher incidence of early reoperation risks if the exact geometry is not maintained.…”

Section: Discussionmentioning

confidence: 99%

“…However, the technique is difficult, has a learning curve, and the technique itself has a higher incidence of early reoperation risks if the exact geometry is not maintained. Willems and colleagues showed that the learning curve associated with ST is a major reason for early reoperation (24). RRT is easier to perform but reoperations after this technique are difficult.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

et al. 2012

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Patient adapted valve selection: biological vs. mechanical heart valve replacement in aortic valve diseases

et al. 2001

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Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced.In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented.Due to the fact that a biological prosthesis has a durability of 12-15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited.

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