title: Valve-related events after aortic root replacement with cryopreserved aortic homografts.
abstract: BACKGROUND
  Aortic root replacement with aortic homografts for various pathologic conditions involving the aortic root has yielded good early results. To assess mid-term valve-related events, a follow-up study was conducted.
  
  
  METHODS
  From February 1989 through January 2003, 213 patients with a mean age of 51.3 +/- 11.8 years underwent aortic root replacement with a cryopreserved aortic homograft. Bacterial endocarditis (58.7%) was the predominant indication for surgery (native valve endocarditis, n = 73; prosthetic valve endocarditis, n = 52). Of the 197 hospital survivors, 194 were entered in the follow-up study (98.5% complete). Endpoints of the study were death, valve-related death, reoperation for valve failure, endocarditis, thromboembolic events, and anticoagulant-related bleeding events. Follow-up was conducted between February and April 2003.
  
  
  RESULTS
  Overall hospital mortality was 7.5% (n = 16; 70% confidence limits, 5.6% to 9.4%). Mean follow-up was 5.8 years (range, 0.3 to 14.3). In total, 20 late deaths occurred (10.3%); of these, 5 were valve-related. The overall survival at 5 and 10 years is 87.3% +/- 2.4% and 70.8% +/- 5.3%, respectively. Twenty-one patients (10.8%) required reoperation, either for structural valve deterioration (n = 12), false aneurysm (n = 3), endocarditis of the homograft (n = 3), or for other reason (n = 3). Mortality for reoperation was 28.6% (n = 6). Five-year and 10-year freedom from reoperation is 94.5% +/- 1.8% and 76.4% +/- 5.3%, respectively. Endocarditis of the homograft was reported in 4 patients (3.2%), of whom 1 patient was treated medically and 3 required reoperation. Thromboembolic events (n = 1) and anticoagulant-related bleeding events (n = 0) were rarely seen. A recent echocardiographic study was available in 124 patients (71.3%). Aortic regurgitation grade I to II was reported in 121 patients (97.6%).
  
  
  CONCLUSIONS
  Cryopreserved aortic homografts function well on mid-term evaluation. The incidence of structural valve failure is acceptable. Reoperations for homograft endocarditis carry a high mortality rate.
authors.affiliation: Department of Cardiothoracic Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands. a_kaya33@hotmail.com
authors.forename: Abdullah
authors.initials: A
authors.lastname: Kaya
authors.forename: Marc A
authors.initials: MA
authors.lastname: Schepens
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Morshuis
authors.forename: Robin H
authors.initials: RH
authors.lastname: Heijmen
authors.forename: Aart
authors.initials: A
authors.lastname: Brutel de la Riviere
authors.forename: Karl M
authors.initials: KM
authors.lastname: Dossche
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000637:transplantation*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D015925:Cryopreservation; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous