title: Patient outcome and valve performance following a second aortic valve homograft replacement.
abstract: BACKGROUND
  Homograft valves offer many advantages; however, there is concern about their use in second aortic valve replacement because of the complexity of the procedure and the possibility of accelerated degeneration.
  
  
  RESULTS
  One hundred and forty-four patients underwent a second aortic homograft replacement between 1973 and 1997 (mean follow-up 6.5+/-5 years, range 1 to 20 years). Eighty-three were male, and 61 were female, aged 17 to 77 years, mean 49.0 years. All patients had undergone previous aortic valve replacement with a homograft. The indication for reoperation was aortic regurgitation in 75 patients (52.1%), aortic stenosis in 28 (19.4%), and mixed aortic valve disease in 41 (28.5%). Root replacement was performed in 54 patients (38%) and subcoronary in 90 (62.5%). Early mortality was 3.4%. The actuarial survival rate was 93% and 82% at 5 and 10 years, respectively. Freedom from tissue degeneration was 96% and 80% at 5 and 10 years, respectively, and freedom from reoperation was 97% and 82% at 5 and 10 years, respectively.
  
  
  CONCLUSIONS
  This study shows that a second aortic valve homograft replacement results in good early and long-term survival. Accelerated degeneration does not occur. Left ventricular performance is improved, and earlier surgery could further improve outcome, indicating that an aortic homograft is a safe, durable option for patients requiring a second aortic valve replacement.
authors.affiliation: Academic Department of Cardiac Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Hasnat
authors.forename: E J
authors.initials: EJ
authors.lastname: Birks
authors.forename: J
authors.initials: J
authors.lastname: Liddicoat
authors.forename: J K
authors.initials: JK
authors.lastname: Hon
authors.forename: S
authors.initials: S
authors.lastname: Edwards
authors.forename: S
authors.initials: S
authors.lastname: Glennon
authors.forename: M H
authors.initials: MH
authors.lastname: Yacoub
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery* / Q000637:transplantation*; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D014184:Transplantation, Homologous