title: Pulmonary homografts for aortic valve replacement: long-term comparison with aortic grafts.
abstract: OBJECTIVE
  The use of homografts for aortic valve replacement (AVR) is an alternative to mechanical or biological valve prostheses, especially in younger patients. This retrospective comparative study evaluated our single-center long-term results, with a focus on the different origins of the homografts.
  
  
  METHODS
  Since 1992, 366 adult patients have undergone AVR with homografts at our center. We compared 320 homografts of aortic origin and 46 homografts of pulmonary origin. The grafts were implanted via either a subcoronary technique or the root replacement technique. We performed a multivariate analysis to identify independent factors that influence survival. Freedom from reintervention and survival rates were calculated as cumulative events according to the Kaplan-Meier method, and differences were tested with the log-rank test.
  
  
  RESULTS
  Overall mortality within 1 year was 6.5% (21/320) in the aortic graft group and 17.4% (8/46) in the pulmonary graft group. In the pulmonary graft group, 4 patients died from valve-related complications, 1 patient died after additional heterotopic heart transplantation, and 1 patient who entered with a primary higher risk died from a prosthesis infection. Two patients died from non-valve-related causes. During the long-term follow-up, the 15-year survival rate was 79.9% for patients in the aortic graft group and 68.7% for patients in the pulmonary graft group (P = .049). The rate of freedom from reoperation was 77.7% in the aortic graft group and 57.4% in the pulmonary graft group (P < .001). The reasons for homograft explantation were graft infections (aortic graft group, 5.0%; pulmonary graft group, 6.5%) and degeneration (aortic graft group, 7.5%; pulmonary graft group, 32.6%).
  
  
  CONCLUSIONS
  Our study demonstrated superior rates of survival and freedom from reintervention after AVR with aortic homografts. Implantation with a pulmonary graft was associated with a higher risk of redo surgery, owing to earlier degenerative alterations.
authors.affiliation: Department of Cardiac Surgery, University Hospital, Ludwig-Maximilians University, Marchioninistrasse 15, Munich, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Vogt
authors.forename: Anke
authors.initials: A
authors.lastname: Kowert
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: Martin
authors.initials: M
authors.lastname: Oberhoffer
authors.forename: Ingo
authors.initials: I
authors.lastname: Kaczmarek
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
authors.forename: Eckehard
authors.initials: E
authors.lastname: Kilian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D055815:Young Adult