Pulmonary autograft versus aortic homograft for aortic valve replacement: interim results from a prospective randomized trial.
OBJECTIVE
Although pulmonary autografts offer advantages over aortic homografts, they may also carry additional risks. We reviewed the interim results of a prospective randomized trial of autograft versus homograft aortic valve replacement (AVR) to determine if the greater complexity of the autograft insertion is justified, particularly with regard to time-related hemodynamic function.


METHODS
A total of 182 patients (82% male, 18% female; mean age 37.2 +/- 14.3 years; range: 2-64 years) with isolated aortic valve disease were randomized to pulmonary autograft (group A, n = 97) or aortic homograft (group H, n = 85); 42% had previous aortic valve surgery and 19% had native or prosthetic valve endocarditis. Follow up included annual outpatient visits and echocardiography.


RESULTS
Autograft AVR required longer cross-clamp (41%) and bypass (43%) times, but did not result in significantly more bleeding, longer recovery or more complications. One 30-day death occurred in group A (1%), and three deaths in group H (4%). Median follow up was 33.9 months (range: 1-61 months). There was one late death in each group, three reoperations in group A (all for pulmonary homografts), and three in group H (including two aortic homograft reoperations, both in children). There were no autograft reoperations. There were no other valve-related events. At 48 months, actuarial survival and reoperation-free survival rates were 97.8% and 94.2% in group A, and 95.3% and 87.7% in group H (p = NS). Echocardiography showed near-perfect function in all autografts, but early signs of subclinical dysfunction in many homografts.


CONCLUSIONS
Both autograft and homograft AVR are safe and produce good intermediate-term results. Early homograft degeneration appears to favor autografts in children. The echocardiographic findings may translate into superior long-term autograft durability and hemodynamics.
Aklog
L
L
Royal Brompton-Harefield NHS Trust, Harefield, UK.
Carr-White
G S
GS
Birks
E J
EJ
Yacoub
M H
MH
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D015996:Survival Rate; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous