Long-term follow-up of patients with the antibiotic-sterilized aortic homograft valve inserted freehand in the aortic position.

Barratt‐Boyes, B. G.; Roche, A. F.; Subramanyan, Ram Kumar; Pemberton, J. R.; Whitlock, R. M. L.

doi:10.1161/01.cir.75.4.768

Cited by 187 publications

(46 citation statements)

References 31 publications

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“…4 Homograft valves are used in the aortic position and do not require long-term anticoagulation. 14 There is limited informa-tion on the survival and valve complications of young women with homografts and no information on the effect of pregnancy on valve survival. 15,16 In this study, we investigated which type of valve replacement (mechanical, bioprosthetic, or homograft) was associated with the greatest long-term survival in young women and compared the rate of valve complications with each valve type.…”

Section: See P 2613mentioning

confidence: 99%

Long-Term Survival and Valve-Related Complications in Young Women With Cardiac Valve Replacements

et al. 1999

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Background-The type of cardiac valve replacement associated with the lowest health risks for young women who may undergo pregnancies is unknown. We investigated which valve type was associated with greatest patient and valve survival and the effect of pregnancy on valve loss. Methods and Results-In this retrospective study, all women 12 to 35 years old who underwent valve replacements between 1972 and 1992 at Greenlane Hospital were identified, and follow-up was available in 93%. The 232 women were followed up for 1499 patient-years. Ten-year survival of women with mechanical (nϭ178), bioprosthetic (nϭ73), and homograft (nϭ72)

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Section: See P 2613mentioning

confidence: 99%

Long-Term Survival and Valve-Related Complications in Young Women With Cardiac Valve Replacements

et al. 1999

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“…4,5 Preservation methods included chemical preservation, irradiation, and freeze drying but resulted in an unacceptable incidence of structural deterioration. 6 Improved results were then obtained with antibiotic sterilization 7 and cryopreservation. Many centers now use cryopreserved heart valves based on work by O'Brien et al 8 However, significant controversy remains regarding valve preservation, because the effects of the various preservation techniques on allografts have not been clearly defined.…”

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confidence: 99%

Cryopreservation of Rat Aortic Valves Results in Increased Structural Failure

Légaré

Lee²

2000

Circulation

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Background-The cause of valve allograft failure is most likely multifactorial and may include mechanical, immunological, and other factors. Cryopreservation of these valves is often used to extend storage times. However, there has been considerable confusion as to the effects of cryopreservation on valve durability. Our objective was to determine the effects of cryopreservation on histopathological changes in rat aortic valve grafts. Methods and Results-Syngeneic rat aortic valve grafts (Lewis to Lewis; nϭ24) and allogeneic rat aortic valve grafts (Brown Norway to Lewis; nϭ24) were implanted infrarenally, either fresh or after cryopreservation. At 7, 14, and 28 days, the valves were explanted, and histological and immunohistochemical examinations were performed in a blinded fashion. Fresh syngeneic graft leaflets retained their normal structure for the 28-day period of observation. Cryopreserved syngeneic grafts showed retrovalvar thrombus formation, with leaflet destruction at 7, 14, and 28 days. Fresh allogeneic graft leaflets showed significant leaflet thickening and progressive destruction at 14 and 28 days. Cryopreserved allogeneic grafts had evidence of retrovalvar thrombus formation with leaflet destruction at 7, 14, and 28 days. Cryopreserved syngeneic grafts resulted in significant infiltration of mononuclear (ED1 ϩ ) cells not seen with fresh syngeneic grafts but similar to fresh allogeneic grafts. All allogeneic grafts resulted in significant infiltration of T-lymphocytes (CD3 ϩ , CD8 ϩ , CD43 ϩ ). Conclusions-Cryopreservation appears to predispose syngeneic and allogeneic rat aortic valve leaflets to accelerated injury and destruction.

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“…Our results are also in agreement with previously published data that showed that AAV primary degeneration rapidly accelerates 10 years after the operation when using the subcoronary approach. 7,11,28 Although our study suggests that in the root replacement technique AAV dysfunction does not accelerate after this time period, a follow-up of Ͼ15 years is required to strengthen our findings. In addition, we have shown that there is a different echocardiographic pattern of AAV degeneration in different types of surgical valve replacement procedures.…”

Section: Resultsmentioning

confidence: 57%

“…6 -10 However, like other tissue valves, AAV durability is still suboptimal. [11][12][13] AAV degeneration usually accelerates 10 to 15 years after implantation, making a reoperation a likely scenario for younger patients. 7 The causes of AAV degeneration are under intense investigation, but they seem to be complex and multifactorial.…”

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confidence: 99%

Primary Aortic Valve Replacement With Cryopreserved Aortic Allograft

et al. 2002

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Background-Despite the many advantages of an aortic allograft valve (AAV) over a prosthetic aortic valve, its durability is suboptimal. The aims of the present study were to document characteristic features of AAV dysfunction and to investigate factors influencing the development of such dysfunction. Methods and Results-A group of 570 patients (mean age, 48Ϯ16 years) with a cryopreserved AAV underwent a follow-up echocardiographic study (mean time after surgery, 6.8 years; range, 1.0 to 22.9 years). Significant AAV regurgitation was present in 14.7% of patients, and AAV stenosis was present in 3.2%. The root replacement subgroup had the smallest number of patients with significant AAV regurgitation (5.0%) compared with the subcoronary (23.0%) or the inclusion cylinder technique subgroup (14.7%). After 10 to 15 years after AAV replacement, grade Ն2 AAV dysfunction was present in 40% of patients in the subcoronary subgroup, but no significant dysfunction was observed in patients in the root replacement subgroup (PϽ0.001). Smaller host aortic annulus size in both subcoronary (coefficient, Ϫ0.145; Pϭ0.013) and root replacement subgroups (coefficient, Ϫ0.249; Pϭ0.011) was associated with more frequent AAV dysfunction (grade Ն2). In addition, significant AAV dysfunction was more frequent when patients were younger (coefficient, Ϫ0.020; Pϭ0.015) in the subcoronary subgroup and the donor was older (coefficient, 0.054; Pϭ0.019) in the root replacement subgroup. Conclusions-The present study indicates that the root replacement technique is associated with less frequent AAV degeneration. Our findings should help in establishing more strict selection criteria for surgical replacement procedure type and patient/donor factors for AAV replacement and, therefore, could lead to improve AAV longevity.

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Long-term follow-up of patients with the antibiotic-sterilized aortic homograft valve inserted freehand in the aortic position.

Abstract: A series of 252 isolated aortic homograft valves in 248 patients have been followed for 9 to 16.5 years (mean 10.8

Cited by 187 publications

References 31 publications

Long-Term Survival and Valve-Related Complications in Young Women With Cardiac Valve Replacements

Long-Term Survival and Valve-Related Complications in Young Women With Cardiac Valve Replacements

Cryopreservation of Rat Aortic Valves Results in Increased Structural Failure

Primary Aortic Valve Replacement With Cryopreserved Aortic Allograft

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