European Journal of Cardio-Thoracic Surgery, Vol 11, 910-916, Copyright © 1997 by European Association for Cardio-thoracic Surgery
The pulmonary homograft as aortic valve substitute: 7 years' follow up
R Mair, F Peschl, C Gross, U Klima, H Hinterreiter and P Bruecke
Departement of Surgery I, General Hospital Linz, Austria.
OBJECTIVE: The advantages of the aortic valve homograft high resistance to
infective endocarditis, low risk of thromboembolism, low gradient and
excellent long term results are well known. Trying to extend these
advantages to a greater number of patients, we used pulmonary homografts as
aortic valve substitute, based on the experimental evidence, that they can
withstand the higher stress in systemic circulation. METHODS: From
September 1988 to August 1994 175 patients (103 men, 72 women, mean age
61.75 +/- 12.92 years) underwent aortic valve replacement with a
cryopreserved pulmonary homograft. All valves were taken from our own
homograft bank. They were inserted freehand intraaortically, 162 in
subcoronary position, 13 as intraaortic cylinder. All patients were
followed clinically and by colorflow Doppler echocardiography in 3-12 month
intervals. RESULTS: Patients, 8, died perioperatively (4.57%). None of the
deaths was valve related. Patients, 2, had to be reoperated during the
perioperative period due to severe valvular incompetence 165 patients were
followed up to a period of 7.5 years (mean interval 3.83 +/- 1.45 years).
Patients, 30, died, 13 deaths (7.42%) must be regarded as valve related.
Patients, 22, (12.52%) had to be reoperated due to severe graft
incompetence. Patients, 9 (5.14%), acquired prosthetic endocarditis.
CONCLUSION: Due to our results, high rate of valve related deaths, high
rate of graft failure and high rate of prosthetic endocarditis, we must
state that the pulmonary homograft did not fulfil our expectations and
presently we can not recommend it as an aortic valve substitute.
