Late Outcomes Following Freestyle Versus Homograft Aortic Root Replacement

Abstract

In this patient group, late survival is similar after homograft versus Freestyle root replacement. However, Freestyle aortic root replacement is associated with significantly less progressive aortic valve dysfunction and a lower need for reoperations.

Reoperation of Left Heart Valve Bioprostheses According to Age at Implantation

“…Aortic valve allografts have worse freedom from reoperation compared with stentless valves. 22 In turn, stentless valves may have worse freedom from reoperation compared with stented xenografts. In a prospective randomized trial, 12-year freedom from reoperation was 92Ϯ5% with the Carpentier-Edwards pericardial valve, compared with 75Ϯ5% with the Toronto SPV valve (Pϭ0.7).…”

Mid- to long-term outcomes of cardiovascular tissue replacements utilizing homografts harvested and stored at Japanese institutional tissue banks

“…12,13 In addition, recent advances in biologic valves may make them more acceptable than homograft valves. 14,15 Despite their negative features, homografts still have a strong appeal to surgeons because of their excellent handling characteristics during fragile tissue reconstruction, particularly in active endocarditis [16][17][18][19] and at the time of the Ross operation. 20,21 We established our institutional cryopreservation bank for CV tissues, because Japan has no national legislation or organization for tissue transplantation.…”

“…Recently, Smedira et al 14 and El-Hamammsy et al 15 reported that pericardial prosthetic valves or free-style porcine valves have better long-term durability than homografts in the aortic position for aortic valve disease uncomplicated by active endocarditis. Published experiences 26,27 and our own experiences indicate that SHVD increases more over time after subcoronary implantation than is seen for aortic root replacement.…”

Surgical Management of the Aortic Root

“…Homografts were found to have a higher likelihood to need a second operation and a higher rate of root degeneration and calcification. [91] Homographs are commonly indicated in patients with a history of endocarditis. The major factor that deters the use of biologics is long-term degeneration of the biologic material when compared synthetic grafts.…”

“…El-Hamamsy et al compared the Freestyle graft with homograft aortic root replacement in a prospective, randomized trial. [139] Onehundred sixty-six patients with an average age of 65 years had a mean follow-up of 7.6 years. Significant conclusions were made from this data including an improved age of survival (80 vs. 77 years), lower rate of reoperation (100% vs. 90%), and echocardiographically patients had less signs of valvular deterioration (86% vs. 30%) in the FreeStyle group.…”