title: Outcome after homograft redo operation in aortic position.
abstract: OBJECTIVE
  Since 1992, homografts have been implanted in our institution. After initial sub-coronary implantation of the homograft, our preferred technique for aortic-valve replacement with homografts became root replacement, which poses a surgical challenge whenever redo procedures are necessary. The aim of the present study was to evaluate the outcome after homograft redo surgery, based on prospective data from the biggest patient cohort in Germany for this procedure.
  
  
  METHODS
  Between May 1992 and August 2009, 363 adult patients underwent aortic-valve replacement with homografts in our cardiac surgery department. Homograft replacement was indicated in 90 of these 363 patients due to degenerative or infective conditions, and these were analysed.
  
  
  RESULTS
  In these 73 male and 17 female patients (mean age at redo operation 62.0 years), homograft explantation was necessary due to infection (n = 14) or degeneration (stenosis n = 19, regurgitation > II° n = 57). Mean time between homograft implantation and redo operation was 8.4 ± 3.6 years (range 0.0-15.5 years). Redo valve replacement through the aorta/homograft was done in 86 cases (valve into homograft wall = 80, total replacement of the homograft = 6) and trans-apical homograft replacement with an Edwards Sapien® Trans-catheter valve in four. Thirteen additional procedures were performed: bypass surgery (n = 1), mitral-valve repair (n = 6), replacement of the ascending aorta (n = 5) and tricuspid-valve repair (n = 1). Thirty-day mortality was 8.9% (n = 8, all of these patients presented with a homograft infection; five patients had a homograft reinfection). Survival rates after 1 and 5 years were 86.0% and 77.4%, respectively.
  
  
  CONCLUSIONS
  The risk for a redo procedure after aortic-valve replacement with a homograft seems to be acceptable when compared with other prostheses. Mortality was, however, elevated in patients with a homograft infection. Trans-apical procedures are safe and feasible and might be our preferred technique for the future. Valve infections still remain a contraindication for trans- apical procedures.
authors.affiliation: Department of Cardiac Surgery, Ludwig-Maximilians-University, University Hospital Grosshadern, Munich, Germany. Anke.Kowert@med.uni-muenchen.de
authors.forename: Anke
authors.initials: A
authors.lastname: Kowert
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Vogt
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
authors.forename: Eckehard
authors.initials: E
authors.lastname: Kilian
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001021:Aortic Valve / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000601:surgery; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome