title: Aortic valve reoperation after homograft or autograft replacement.
abstract: OBJECTIVE
  With increasing use of homograft and autograft aortic valves for aortic valve replacement (AVR), more patients will be presenting for aortic valve reoperation due to structural degeneration of the homograft or autograft valve. Management options include homograft re-replacement, which may require extensive surgery, versus AVR with a mechanical valve or a stented xenograft. Here, results are reported in 18 consecutive patients who underwent aortic valve re-replacement (AVreR) after previous homograft or autograft insertion.
  
  
  METHODS
  Between May 1976 and March 2001, 18 patients underwent AVR after previous homograft (n = 16) or autograft (n = 2) insertion. The homograft or autograft had been implanted as a full root in eight patients (44%), as a mini-root in one (6%), and in the subcoronary position in nine (50%). Indication for the reoperation was structural valve degeneration (n = 14; 72%) in one occasion combined with aneurysm of the homograft, or endocarditis (n = 4; 22%), and seven (39%) presented as a non-elective procedure. The median interval between the two operations was 5.4 years (range: 0.3-10.8 years).
  
  
  RESULTS
  Fourteen patients (78%) received either a mechanical valve (n = 12; 67%) or a stented xenograft valve (n = 2; 11%). Four others (22%) required root re-replacement with either another homograft (n = 3) or a mechanical valved conduit (n = 1) for endocarditis (n = 2) or an associated aneurysm (n = 2). Overall hospital mortality was 11% (n = 2) due to stroke (n = 1) or respiratory failure (n = 1). Two patients died 3.1 and 7.0 years after the procedure.
  
  
  CONCLUSIONS
  Aortic valve reoperation after previous homograft or autograft implantation is a rare operation and presents a high-risk group. A simplified approach was preferred by utilizing mechanical or stented xenograft valves at reoperation, while homograft re-replacement was reserved for endocarditis or an associated aneurysm.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Byrne
authors.forename: A N
authors.initials: AN
authors.lastname: Karavas
authors.forename: L
authors.initials: L
authors.lastname: Aklog
authors.forename: D H
authors.initials: DH
authors.lastname: Adams
authors.forename: A C
authors.initials: AC
authors.lastname: Cheung
authors.forename: L H
authors.initials: LH
authors.lastname: Cohn
authors.forename: S F
authors.initials: SF
authors.lastname: Aranki
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012307:Risk Factors; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous