Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

Abstract

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.

Contemporary outcomes after surgical aortic valve replacement with bioprostheses and allografts: a systematic review and meta-analysis

“…A possible explanation is that the indication for using allografts for AVR has changed over time from a broad range of patients to mostly complex patients with active endocarditis [ 4 , 6 ]. Indeed, in this review, three relatively recent studies with endocarditis as indication for surgery in more than 40% of the patients reported relatively high early mortality risks [ 23 – 25 ].…”

“…This can also explain why the late mortality rate is lower in studies on allografts with a more recent implantation period; in recent years, the indication for using allografts for AVR is often endocarditis [ 4 , 6 ]. Indeed, three relatively recent studies in this review, where the indication for surgery was endocarditis in more than 40% of the patients, reported relatively low late mortality rates [ 23 – 25 ]. Furthermore, the low mean age of two studies with a high proportion of concomitant procedures [ 33 , 34 ] might explain why studies with a high proportion of concomitant procedures report lower late mortality rates.…”