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J Thorac Cardiovasc Surg 1998;115:371-380
© 1998 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
From the Divisionof cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md.,a and the Division of Cardiovascular and Thoracic Surgery, Department of Surgery, LDS Hospital, Salt Lake City, Utah.b
Read at the Twenty-third Annual Meeting of the Western Thoracic Surgical Association, Napa, Calif., June 25-28, 1997.
Received for publication July 8, 1997; revisions requested Sept. 29, 1997; revisions received Oct. 31, 1997; accepted for publication Oct. 31, 1997. Address for reprints: Donald B. Doty, M.D. 324 Tenth Ave., #160, Salt Lake City, UT 84103.
Abstract
Objective: Cryopreserved aortic allograft can be used for aortic valve replacement in congenital, rheumatic, degenerative, and infected native valve conditions, as well as failed prosthetic valves. This study was conducted to determine the long-term results of aortic valve replacement with cryopreserved aortic allografts. Methods: Aortic valve replacement with cryopreserved aortic allografts was performed in 117 patients from July 1985 until August 1996. All patients requiring aortic valve replacement regardless of valve disease were considered for allograft replacement; the valve was preferentially used in patients under age 55 years and in the setting of bacterial endocarditis. Four operative techniques involving cryopreserved aortic allografts were used: freehand aortic valve replacement with 120-degree rotation, freehand aortic valve replacement with intact noncoronary sinus, aortic root enlargement with intact noncoronary sinus, and total aortic root replacement. Valve function was assessed by echocardiography during the operation in 78 patients (66%) and after the operation in 77 patients (65%). Results: One-hundred eighteen aortic valve replacements with cryopreserved aortic allografts were performed on 117 patients; mean age was 45.6 years (range 15 to 83 years) and mean follow-up was 4.6 years (range up to 11 years). Intraoperative echocardiography disclosed no significant aortic valve incompetence. There were four operative deaths (3%) and seven late deaths; freedom from valve-related mortality at 10 years was 9:3% ± 4.55%. New York Heart Association functional status at latest follow-up was normal in 98 (94%) patients. On postoperative echocardiography, 90% had no or trivial aortic valve incompetence. Freedom from thromboembolism at 10 years was 100% and from endocarditis, 98% ± 2.47%. Seven (6%) patients required valve explantation, four for structural deterioration. At 10 years, freedom from reoperation for allograft-related causes was 92% ± 3.47%. Conclusions: Aortic valve replacement with cryopreserved aortic allografts can be performed with low perioperative and long-term mortality. Most patients have excellent functional status, and reoperation for valve-related causes is unusual. Aortic valve replacement with cryopreserved aortic allografts demonstrates excellent freedom from thromboembolism, endocarditis, and progressive valve incompetence. Replacement of the aortic valve with an aortic valve allograft has been shown in several series to have favorable long-term results in hemodynamic performance and freedom from reoperation. The allograft valve is particularly resistant to thromboembolism and is well suited for use in the setting of active valve infection. Late valve failure, an uncommon event, is most commonly the result of progressive valve incompetence.
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