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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 48-55, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WW Angell, JH Oury, JJ Lamberti and J Koziol
Of 581 aortic allografts implanted since 1967, 421 were analyzed for
structural deterioration. This series is unique in that it includes
patients from the early allograft experience. All allografts were cleanly
procured, antibiotic sterilized, and either stored at 4 degrees C for up to
8 weeks or frozen to liquid nitrogen temperatures with cryopreservation to
preserve the viable cusp fibroblasts. There were 25 frozen mounted aortic
valves with a median time to valve failure of 12.1 years, which was not
significantly different from the 12.5-year period for 114 fresh free-sewn
aortic valves. The median time to valve failure was 6.6 years for 90
fresh-mounted aortic valves and 8.6 years for 192 fresh-mounted mitral
valves (p = 0.05). The difference between all mounted and unmounted grafts
was significant (p = 0.0001). In all groups, viable fibroblasts were
present in specimens explanted up to 5 years after the operation. All
specimens returned after more than 10 years were almost totally acellular.
Evidence of increased collagen, suggesting that the fibroblasts survive
implantation and then gradually die, was present in all specimens. This
series suggests that durability of the unmounted viable allograft for
aortic valve replacement is greater than for other types of tissue valves.
Pre-mounted allografts for aortic or mitral valve replacement have a median
survival of 8 years and are not more durable than other tissue valves.
ARTICLES
Durability of the viable aortic allograft
Division of Cardiac Surgery, Scripps Clinic and Research Foundation, La Jolla, CA 92037.
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