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J Thorac Cardiovasc Surg 2000;120:148-155
© 2000 The American Association for Thoracic Surgery

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

Pulmonary homograftShould it be used in the aortic position?

From Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Address for reprints: A. Sampath Kumar, MCh, Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India (E-mail: askumar{at}medinst.ernet.in ).

Objective: Retrospective analysis was performed to determine the suitability of pulmonary homograft as an aortic valve substitute.
Methods: From January 1994 through June 1999, 147 patients (mean age, 32.2 ± 17.3 years) underwent aortic valve replacement with either an aortic homograft (group 1: n = 103, 25 fresh antibiotic preserved and 78 cryopreserved) or a pulmonary homograft (group 2: n = 44, 11 antibiotic preserved and 33 cryopreserved). In group 1 a scalloped subcoronary technique was used in 64 patients, and a root replacement technique was used in 39 patients. In group 2 the scalloped subcoronary technique was used in 34 patients, and the root replacement technique was used in 10 patients.
Results: There were 131 operative survivors (group 1 = 91; group 2 = 40). Follow-up ranged from 2 to 62 months. In group 1 none of the patients had significant aortic regurgitation during the hospital stay. Three patients (all having undergone the scalloped subcoronary technique) had moderate aortic regurgitation after 6 to 32 months. In group 2, 10 patients (9 having undergone the scalloped subcoronary technique and 1 having undergone the root replacement technique) developed significant regurgitation: 2 intraoperatively, 5 in the early postoperative period before discharge from the hospital, and 3 during late follow-up 6 to 12 months postoperatively. Among the various risk factors analyzed for overall homograft failure, use of a pulmonary homograft was the single independent predictor of valve failure (odds ratio, 8.6; 95% confidence interval, 1.9-39; P = .006).
Conclusion: Pulmonary homograft, when inserted by means of a scalloped subcoronary technique, is not a suitable aortic valve substitute.

This article has been cited by other articles:

				S. Talwar, R. Mohapatra, A. Saxena, R. Singh, and A. S. Kumar Aortic Homograft: A Suitable Substitute for Aortic Valve Replacement Ann. Thorac. Surg., September 1, 2005; 80(3): 832 - 838. [Abstract] [Full Text] [PDF]

				D. R. Koolbergen, M. G. Hazekamp, E. de Heer, F. van Hoorn, H. A. Huysmans, J. A. Bruijn, and R. A.E. Dion Structural degeneration of pulmonary homografts used as aortic valve substitute underlines early graft failure Eur. J. Cardiothorac. Surg., November 1, 2002; 22(5): 802 - 807. [Abstract] [Full Text] [PDF]