Aortic homograft improves hemodynamic performance and clinical outcome at mid-term follow-up.
BACKGROUND
Cryopreserved homograft is currently considered an excellent choice for the replacement of a diseased aortic valve in adults and it is the first choice for 1 with aortic endocarditis. The aim of this study was to analyze our single institution experience with the cryopreserved aortic homograft by a mid-term follow-up.


METHODS
Between December 1996 and September 2003, 46 consecutive patients underwent aortic valve replacement using either aortic or pulmonary homograft. The risk profile was moderate-to-high, with a mean log EuroSCORE of 6.33+/-5.12. All patients were periodically evaluated at discharge, at 6 and 12 months, and yearly thereafter, to assess their clinical status and hemodynamic performance by comparing the ejection fraction, left ventricular mass index, mean gradient, effective orifice area index, and diastolic and systolic eccentricity indexes.


RESULTS
The overall 30-day mortality was 4.3%. At univariate analysis, the significant determinants of in-hospital mortality were: aortic dissection (p < 0.001), urgent operation (p = 0.05) and a log EuroSCORE > 10 (p = 0.05). At multivariate analysis no independent predictors of in-hospital mortality were found. At 5 years of follow-up, the survival was 91.3+/-5.0%, the freedom from reoperation was 95.8+/-4.1%, the freedom from sudden death was 96.1+/-3.9%, and the freedom from readmission for congestive heart failure was 94.1+/-3.1%. In patients with either prevalent aortic valve stenosis or prevalent aortic valve insufficiency, a significant improvement in the preoperative ejection fraction during follow-up (49+/-4 vs 51+/-7%; F = 5.1, p = 0.04 and 50+/-10 vs 53+/-10%; F = 7.1, p = 0.01 respectively) and a significant reduction in the preoperative left ventricular mass index during follow-up (202+/-55 vs 143+/-28 g/m2; F = 7.5, p = 0.008 and 177+/-49 vs 138+/-24 g/m2; F = 8.8, p < 0.001) were recorded.


CONCLUSIONS
Replacement of the diseased aortic valve with a cryopreserved homograft offers clear advantages in terms of excellent hemodynamics, resistance to infection, and a negligible incidence of postoperative regurgitation.
D'Alfonso
Alessandro
A
Department of Cardio Thoracic Surgery, University Hospital, Pisa, Italy.
Verunelli
Francesco
F
Mariani
Massimo A
MA
Nardi
Carmela
C
Bellieni
Luca
L
Grandjean
Jan G
JG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000637:transplantation*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D015925:Cryopreservation; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000637:transplantation*; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome