title: Pulmonary homograft: should it be used in the aortic position?
abstract: OBJECTIVE
  Retrospective analysis was performed to determine the suitability of pulmonary homograft as an aortic valve substitute.
  
  
  METHODS
  From January 1994 through June 1999, 147 patients (mean age, 32.2 +/- 17.3 years) underwent aortic valve replacement with either an aortic homograft (group 1: n = 103, 25 fresh antibiotic preserved and 78 cryopreserved) or a pulmonary homograft (group 2: n = 44, 11 antibiotic preserved and 33 cryopreserved). In group 1 a scalloped subcoronary technique was used in 64 patients, and a root replacement technique was used in 39 patients. In group 2 the scalloped subcoronary technique was used in 34 patients, and the root replacement technique was used in 10 patients.
  
  
  RESULTS
  There were 131 operative survivors (group 1 = 91; group 2 = 40). Follow-up ranged from 2 to 62 months. In group 1 none of the patients had significant aortic regurgitation during the hospital stay. Three patients (all having undergone the scalloped subcoronary technique) had moderate aortic regurgitation after 6 to 32 months. In group 2, 10 patients (9 having undergone the scalloped subcoronary technique and 1 having undergone the root replacement technique) developed significant regurgitation: 2 intraoperatively, 5 in the early postoperative period before discharge from the hospital, and 3 during late follow-up 6 to 12 months postoperatively. Among the various risk factors analyzed for overall homograft failure, use of a pulmonary homograft was the single independent predictor of valve failure (odds ratio, 8.6; 95% confidence interval, 1.9-39; P =.006).
  
  
  CONCLUSIONS
  Pulmonary homograft, when inserted by means of a scalloped subcoronary technique, is not a suitable aortic valve substitute.
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Choudhary
authors.forename: A
authors.initials: A
authors.lastname: Saxena
authors.forename: B
authors.initials: B
authors.lastname: Dubey
authors.forename: A S
authors.initials: AS
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011664:Pulmonary Valve / Q000637:transplantation*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors