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Eur J Cardiothorac Surg 2001;20:835-841
© 2001 Elsevier Science NL

Geometric mismatch between homograft (allograft) and native aortic root: a 14-year clinical experience

Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany

Received 11 December 2000; received in revised form 22 June 2001; accepted 22 June 2001.

Corresponding author. Tel.: +49-30-4593-2021; fax: +49-30-4593-2021
e-mail: yankah{at}dhzb.de

Objectives: We evaluated the effect of homograft/native aortic root geometric matching and mismatching on valve survival and myocardial remodeling. Methods: Between January 1, 1987 and March 2000, a total of 292 patients, aged 1.5–78 years (mean, 46.2 years), underwent freehand subcoronary aortic valve (AVR; n=207) and root (ARR; n=85) replacement with matched and mismatched cryopreserved homografts. All patients had pre- and postoperative two-dimensional Doppler echocardiographic studies. Two-hundred and forty-three survivors, excluding children with complete data on sizing, were followed at a total follow-up time of 1269 patient-years. Seventy percent received matched and 30% received mismatched aortic homografts. The homograft valve sizes ranged from 19 to 28 mm. Results: Hospital death for elective first operation was 2.3%, and late death after a mean follow-up of 52 months was 7.9%. The patient survival at 14 years was 92±2%. By linear regression analysis, matched homografts were equal to or 1–2 mm less than the native aortic annulus (r²=0.73). The valve survival in patients with AVR and ARR was 72±4 and 80±8% at 14 years, respectively. The freedom from reoperation was 92±5, 77±4 and 48±10% at 14 years for matched, oversized and undersized homografts, respectively (P=0.001). The postoperative cardiac index of patients with 22 and 24 mm homografts was 3.8–4.1 l/m², and there was a regression of the left ventricular mass and end-diastolic diameter (P=0.001). Conclusions: The aortic homograft offers an excellent long-term clinical result. A mismatched homograft is a risk factor for postoperative aortic incompetence, reinfection with pseudoaneurysmal formation and reoperation for the freehand subcoronary implantation technique during the first 7 years of the postoperative period. It is prudent therefore to avoid mismatched homografts and use rather a properly sized stentless xenograft if a root replacement is not indicated.

Key Words: Aortic allograft • Geometric mismatch • Ventricular remodeling

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