title: Homografts in aortic position: does blood group incompatibility have an impact on patient outcomes?
abstract: OBJECTIVE
  Aortic homografts are an alternative to mechanical or biological valve prostheses. Homografts are generally not transplanted ABO-compatible while this policy is still under debate. The purpose of this study was to investigate whether ABO compatibility impacts on long-term outcomes or not.
  
  
  METHODS
  Between 1992 and 2009, 363 adult patients with a mean age of 52 years received homografts in aortic position. Donor and acceptor blood groups could be obtained for 335 patients. Sixty-three percent received blood group-compatible (n = 212) (Group iso) and 37% non-blood group-compatible allografts (n = 123) (Group non-iso).
  
  
  RESULTS
  The overall event-free survival (freedom from death or reoperation) was 55.5% (n = 186). In the iso group, the event-free survival was 84.1% at 5 years and 63.3% at 10 years. In the non-iso group, the event-free survival was 79.4% at 5 years and 51.8% at 10 years. 28.5% of patients (n = 35) with ABO-incompatible and 25.5% (n = 54) with ABO-compatible grafts required reoperation. The mean time to reoperation in the iso group was 97.3 vs 90 months in the non-iso group.
  
  
  CONCLUSIONS
  In 17 years of research, we have not yet found a statistical significant difference in blood group incompatibility regarding overall event-free survival. In our opinion, there is no need to use ABO-compatible homografts for aortic valve replacement in adults. Histological and immunohistochemical assays are mandatory to confirm our results.
authors: Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany. ferdinand.vogt@klinikum-nuernberg.de
authors: Ferdinand
authors: F
authors: Vogt
authors: Bernhard Michael
authors: BM
authors: Böll
authors: Anne-Laure
authors: AL
authors: Boulesteix
authors: Eckehard
authors: E
authors: Kilian
authors: Giuseppe
authors: G
authors: Santarpino
authors: Bruno
authors: B
authors: Reichart
authors: Christoph
authors: C
authors: Schmitz
mesh_terms: D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000637:transplantation*; D001787:Blood Group Incompatibility / Q000150:complications* / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006650:Histocompatibility Testing; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000637:transplantation*; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System
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