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The use of homografts for aortic valve replacement (AVR) is an alternative to mechanical or biological valve prostheses, especially in younger patients. This retrospective comparative study evaluated our single-center long-term results, with a focus on the different origins of the homografts.
Since 1992, 366 adult patients have undergone AVR with h...
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Context 1
... 1992 and 1995, homografts (n = 75) were implanted via a subcoronary technique that conserved the patient's aortic root. All other implantations occurred via root replacement, which requires reimplantation of the coronary arteries (n = 291) ( Figure 1). All procedures were performed via a median sternotomy and with cardiopulmonary bypass. ...
Context 2
... was defined as moderate at a mean pressure gradient between 30 and 50 mm Hg and as severe at a mean pressure gradient >50 mm Hg. In addition, we analyzed the effects of the type of graft (aortic versus pul- monary), the implantation technique (subcoronary versus root replacement; Figure 1), and patient sex. Postoperatively, patients underwent thorough echocardiographic reexamina- tions and reinterview evaluations once a year in our outpa- tient department. ...
Context 3
... 10 years, the survival rate was 85.6% in the aortic graft group and 76.0% in the pul- monary graft group (P = .024). During the long-term follow-up (Figure 1), the 15-year survival rate was 79.9% among patients with homografts of aortic origin and 68.7% among patients with homografts of pulmonary origin (P = .049). ...
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Numerous studies have linked prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) to adverse outcomes. Its correlation with long-term survival has been described but with contradicting results. This systematic review and meta-analysis of observational studies aims to determine the hazard of PPM after AVR.
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Citations
... However, so far this has not led to a recommendation to use gender-or blood group-matched allografts. High donor age, young patient age, homograft size mismatching and pulmonary homografts in the aortic position are suggested to be risk factors for valve failure [2][3][4]. Furthermore, implantation technique and sterilization technique also seem to have an impact on long-term valve function, whereas blood group incompatibility apparently does not [2,5]. ...
Factors influencing allograft valve failure in adult patients are still under discussion. There is evidence in heart transplantation that gender mismatching may influence patient outcome. In case of aortic valve replacement with a homograft valve, gender matching is not performed routinely. The aim of this study was to investigate the impact of gender mismatch of human aortic homografts.
Between June 1992 and August 2009, 363 adult patients received aortic or pulmonary homografts in the aortic position. For 350 patients, the following donor-recipient patterns could be investigated: male recipient and male donor (n = 193), male recipient and female donor (n = 64), female recipient and male donor (n = 47), female recipient and female donor (n = 46).
The overall mortality rate was 18.5%. In total, 95 patients (27.1%) needed reoperation during follow-up (mean overall follow-up time was 8.1 years). Event-free survival (i.e. survival without reoperation) of recipients of gender-incompatible homografts was not significantly different compared with recipients who received gender-compatible homografts. Echocardiographic performance of the homograft valve over time was not significantly worse in case of gender incompatibility than in case of gender compatibility.
There was no significant difference between gender-mismatched and matched allografts regarding death, need for reoperation and echocardiographic allograft function during follow-up. Limitations of this study are its retrospective design and the lack of immunohistochemical data to determine the presence of viable cells in explanted valves.
© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
... The implantation technique was also improved from the subcoronary implantation to root replacement with reimplantation of the coronary arteries [16]. The use of pulmonary homografts in aortic position showed an impaired outcome in the long-term follow-up leading to the termination of using those grafts [17]. ...
OBJECTIVES
Aortic homografts are an alternative to mechanical or biological valve prostheses. Homografts are generally not transplanted ABO-compatible while this policy is still under debate. The purpose of this study was to investigate whether ABO compatibility impacts on long-term outcomes or not.METHODS
Between 1992 and 2009, 363 adult patients with a mean age of 52 years received homografts in aortic position. Donor and acceptor blood groups could be obtained for 335 patients. Sixty-three percent received blood group-compatible (n = 212) (Group iso) and 37% non-blood group-compatible allografts (n = 123) (Group non-iso).RESULTSThe overall event-free survival (freedom from death or reoperation) was 55.5% (n = 186). In the isogroup, the event-free survival was 84.1% at 5 years and 63.3% at 10 years. In the non-iso group, the event-free survival was 79.4% at 5 years and 51.8% at 10 years. 28.5% of patients (n = 35) with ABO-incompatible and 25.5% (n = 54) with ABO-compatible grafts required reoperation. The mean time to reoperation in the iso group was 97.3 vs 90 months in the non-iso group.CONCLUSIONS
In 17 years of research, we have not yet found a statistical significant difference in blood group incompatibility regarding overall event-free survival. In our opinion, there is no need to use ABO-compatible homografts for aortic valve replacement in adults. Histological and immunohistochemical assays are mandatory to confirm our results.
Background:
The various uses of biological valves for either aortic or mitral valve replacement have recently increased because of the growing proportion of elderly patients requiring surgery.
Results:
The durability of recent xenografts has been reported to be over 90 % at 10 years after aortic or mitral valve replacement for elderly patients more than 65 years of age, and therefore the guidelines now recommend the use of bioprostheses for patients over 65 years of age. Bioprostheses are also recommended for valve replacement of the right side of the heart by several authors; however, no clear guidelines are available. Trans-catheter aortic valve replacement and percutaneous pulmonary valve implantation are promising procedures for high-risk patients, although evaluation of the long-term durability of these valves is mandatory.
Conclusions:
This article will review the development of the tissue valve for valve surgery.
