Cryopreserved homografts in valve surgery – the experience of one clinic

Abstract

Introduction. Surgical treatment of infective and prosthetic endocarditis using homografts shows good results. Aortic homograft implantation is a common technique, whereas tricuspid and mitral valve replacement with mitral homograft is rare. Multiple valve malformations in infective endocarditis pose a surgical challenge because these patients are usually critically ill and surgical outcomes are often unsatisfactory. In this article, we describe our experience with successful surgical treatment of patients who underwent implantation of cryopreserved homograftsAim: To study the long-term results of cryopreserved homograft implantation, freedom from reoperation, long-term survival, and to demonstrate new technical aspects of homograft implantation.Material and Methods. This is a retrospective analysis of 24 patients operated in our clinic (UKB No. 1 of Sechenov University) between 2015 and 2021. Aortic homograft (AH) in orthotopic position was implanted in 6 patients with active IE. Pulmonary homograft (PH) was implanted in 13 patients: in orthotopic position (n = 10) and in heterotopic position (in the aortic root) (n = 3). Mitral homograft was implanted in 4 patients, with only 1 of them in the orthotopic position, whereas 3 were implanted in the TC position (Table 1). In 1 patient with AK and MC IE extended to the mitral-aortic contact, the use of an aorto-mitral monobloc was requested.Results. In the midterm period, we had available data from all surviving patients. The mean gradient on AC after implantation of aortic homograft and pulmonary homograft in the position of the aortic root was 4.6 ± 1.96 mm Hg, significant regurgitation was absent in all patients, and no cases of reoperation were noted. After orthotopic implantation of pulmonary homografts, the mean gradient was 3.2 ± 1.4 mm Hg, significant regurgitation was absent in all cases. After MG implantation in TC position according to ECHO data all patients have 0–1 degree of regurgitation on the prosthesis, mean pressure gradient was 2,5 ± 0,6 mm Hg. MG was implanted in orthopic position in one case – a 52 years old woman with Bechterew’s disease, mean gradient on IC was 4 mm Hg, regurgitation 0–1 degree.Conclusion. Valve homografts may have more advanced indications than IE. Techniques such as implantation of MG in tricuspidal or orthotopic position and the use of combined homografts show promising results, but require further clinical recruitment and evaluation of the distant period.