Long-Term Outcomes of Homografts in the Aortic Valve and Root Position: A 20-Year Experience

Abstract

BackgroundThe advantages of using a homograft in valve replacement surgery are the excellent hemodynamic profile, low risk of thromboembolism, and low risk of prosthetic valve infection. The aim of this study was to evaluate the long-term outcomes of homograft implantation in the aortic valve position.MethodsThis is a retrospective study of 33 patients (>20 years old) who underwent aortic valve replacement or root replacement with homografts between April 1995 and May 2015. Valves were collected within 24 hours from explanted hearts of heart transplant recipients (<60 years) and organ donors who were not suitable for heart transplantation. The median follow-up duration was 35.6 months (range, 0 to 168 months).ResultsAortic homografts were used in all patients. The 30-day mortality rate was 9.1%. The 1- and 5-year survival rates were 80.0%±7.3% and 60.8%±10.1%, respectively. The 1-, 5-, and 10-year freedom from reoperation rates were 92.3%±5.2%, 68.9%±10.2%, and 50.3%±13.6%, respectively. The 1-, 5-, and 10-year freedom from significant aortic dysfunction rates were 91.7%±8.0%, 41.7%±14.2%, and 25.0%±12.5%, respectively.ConclusionHomografts had the advantages of a good hemodynamic profile and low risk of thromboembolic events, and with good outcomes in cases of aortitis.

Outcomes of Patients after Implantation of the Pericardial All-Biological Valve No-React Aortic Conduit (BioIntegral) for Root Replacement in Complex Surgical Procedures

“…[26][27][28] The use of all biological homografts and allografts is well established and has demonstrated solid results also in larger series. 9,29 Additionally, Etz et al could show no difference in short-and long-term mortality between mechanical and stentless porcine xenograft root replacement in 205 octogenarian patients for various aortic root pathologies with a linearized mortality rate of 3.1% per patient year. 30 The rationale of using the stentless biological material in valve replacement surgery are the excellent hemodynamic profile, low risk of thromboembolism, and low risk of prosthetic valve infection due to the absence of artificial material.…”

“…8 Though the results after homograft implantation are satisfying in several studies, the attempt to use homografts in case of emergency root replacement failed due to limited availability. 9,10 As an alternative option, the Shelhigh No-React biological valve conduit was implanted off the shelf in aortic root position with initially promising results, but was withdrawn by the company after reports of pseudoaneurysm and disastrous cases of early graft failure. 11,12 After anatomical modification and reaccreditation of the latter, a recent study reports that the BioIntegral Bio-Conduit (BioIntegral Surgical Inc., Mississauga, Canada) as an all-biologic bovine pericardial conduit is resistant toward infection, resists calcification, dilatation, and thrombosis, after root replacement for aortic valve endocarditis.…”

An Aortic Root Abscess Presenting as a Suprasternal Pulsatile Mass

“…It has an anterior mitral leaflet (AML), which is very useful for reconstructing the sub-aortic membrane and leaflet if necessary. It has an adequately thick muscle bar/annulus, which gives excellent suture purchase by either continuous or interrupted sutures [3]. Additionally, the epiaortic vessels present in the homograft can be used for fashioning coronary buttons, as in our case.…”

“…(3) While making sutures, care should be taken not to damage the aortic leaflet. (4) Before tying sutures, an appropriately sized Hegar dilator can be kept across the homograft in order to prevent tissue crimping or bucking [3].…”

Recent Advancements in 3D Printing and Bioprinting Methods for Cardiovascular Tissue Engineering

“…Current high-cost therapies include conventional tissue engineering, cell therapy and medical approaches [5,6]. In valve repairment, autografts are widely used by harvesting from autologous cell sources, namely parts of a patient's body with the advent of low risk of thromboembolism and prosthetic valve infection [7]. The end stage heart failure is treated by allografting a heart from a donor, while some valve replacement surgeries employ bovine or porcine heart valves.…”