Fourteen years experience in aortic valve replacement with homografts

Aims: Aortic valve replacement (AVR) using homografts (HG) is an accepted alternative to other prostheses and is established in our department since 1992.

Methods: A total of 427 homografts were implanted in subcoronary technique as well as root replacements. Aortic and pulmonary grafts were used for implantation.

Results: Thirty days mortality was 5.7%; after 10 and 14 years the survival was 84.6% and 78.6% respectively. There were no significant differences between gender, aortic or pulmonary grafts and implantation technique (subcoronary versus root replacement). Thirty one late daths occurred of which 9 deaths were valve-related (all prosthetic infections). Except of 6 TIA's and 1 stroke there were no thrombembolic events recorded. Freedom from reoperation was 78.5% after 10 years and 71.4% after 14 years. Reoperation was necessary in 55 patients due to restenosis (n=21), regurgitation > °II (n=16) and prosthetic infection (n=17); except of 2 cases all graft infection appeared 1000 day after implantation or later. One of the patients was transplanted because of additional ischemic cardiomyopathy. Aortic grafts were superior to pulmonary grafts (p=0.044), the necessity of redo operations was higher in male patients (p=0.005). There were no significant differences between subcoronary versus root replacement technique.

Conclusions: Our data confirm good mid-term-results for aortic valve replacement with homografts. They are vulnerable to infections; aortic grafts are superior to pulmonary grafts.