Are pulmonary homografts subjected to pulmonary hypertension more appropriate for aortic valve replacement than normal pulmonary homografts? Results of echocardiography in a multicentric study.
OBJECTIVE
To compare the function in aortic position of cryopreserved pulmonary homografts subjected to pulmonary hypertension with that of normal cryopreserved pulmonary homografts.


METHODS
Pulmonary valves (52) were implanted in aortic position in different cardiothoracic centres. The valves were classified as follows: Group I-pulmonary hypertension (procured from recipients of heart/heart-lung transplantation, 31 valves), Group II-normal pulmonary pressure (procured from cadavers and multiorgan donors, 21 valves). Regular echocardiographic follow-up was obtained by the implanting centers. Significant echo changes were defined as insufficiency > 2+ and/or stenosis producing a delta P > 30 mm Hg.


RESULTS
Pulmonary homografts showed the following significant echo changes: in the Pulmonary Hypertension Group, 7, 27 and 33% at 12, 24 and 36 months, respectively; in the normal PA Group 10, 37.5 and 80% at 12, 24 and 36 months, respectively. In both groups the most common echocardiographic alteration was homograft insufficiency rather than stenosis. Thus, pulmonary homografts subjected to long-term pulmonary hypertension have significantly less echo changes than normal pulmonary homografts, especially after 12 months (chi 2: P < 0.036).


CONCLUSIONS
These findings suggest that pulmonary valves subjected to pulmonary hypertension might be more appropriate than normal pulmonary homograft for aortic valve replacement, constituting a possible alternative in case of lack of aortic valve homografts. However, the failure of two out of five valves in the longer term must dictate caution while waiting further long-term results.
Gaudino
M
M
European Homograft Bank, Brussels, Belgium.
Van Geldorp
T
T
Daenen
W
W
Kalmar
P
P
Goffin
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000502:physiology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D016041:Heart-Lung Transplantation / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011664:Pulmonary Valve / Q000503:physiopathology / Q000637:transplantation*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome