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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 815-822, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WW Angell, JD Angell, JH Oury, JJ Lamberti and TM Grehl
There is currently a renewed interest in the use of both fresh and
commercially available frozen homograft valves for children and young
adults. This has prompted us to review a series of 32 patients who received
frozen homograft valves for aortic replacement between 1973 and 1975. The
cryogenic technique evolved to include the use of selected antibiotics and
equilibrated dimethyl sulfoxide solution to freeze homografts at a rate of
1 degrees C per minute to liquid nitrogen temperatures of -196 degrees C.
Histologic sections of experimental frozen valves explanted 6 months
postoperatively revealed the presence of viable donor cells, and tissue
culture demonstrated the reproductive capacity of cusp fibroblasts. Of the
32 frozen viable homografts implanted in this series, 23 were inserted as
free-sewn aortic replacements and nine were premounted on stents before
implantation in the aortic position. There were two operative deaths, and
three valves failed as a result of the technical problems of mounting in
one patient and surgical insertion of a free graft in two patients. Of the
22 patients who remained at long-term risk, 13% with free-sewn grafts and
57% with premounted valves underwent reoperation for valve failure. After
10 years of follow-up, 15 (68%) of these patients, 12 (80%) with free-sewn
and three (43%) with premounted valves, are alive with their original valve
in place. Actuarial analysis shows that 58% of the 32 valves implanted are
functional at the beginning of the eleventh year. There have been six late
deaths resulting in an overall actuarial patient survival rate of 79% at 10
years and 69% after 13 years. These clinical results are believed to add
support to our current application of the frozen homograft in selected
patients.
ARTICLES
Long-term follow-up of viable frozen aortic homografts. A viable homograft valve bank
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