The Aortic Homograft: Evolution of Indications, Techniques, and Results in 107 Patients

Prager, Richard L.; Fischer, Carl R.; Kong, Bobby; Byrne, James P.; Jones, D.; Hance, M.LaWaun; Gago, Otto

doi:10.1016/s0003-4975(97)00623-1

Cited by 22 publications

(12 citation statements)

References 16 publications

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“…However, our previous results and the results of others have also shown the advantage of the root replacement technique over the subcoronary technique. 12,24,29 In cases when the complete aortic root is implanted instead of the aortic valve in the subcoronary position, the risk of valve degeneration seems to be smaller. This is due to a lesser mechanical and immunological insult to the valve itself and to the preservation of the "short channel" connecting the left ventricle to the aorta, which can interact well with the surrounding structures.…”

Section: Resultsmentioning

confidence: 99%

Primary Aortic Valve Replacement With Cryopreserved Aortic Allograft

et al. 2002

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Background-Despite the many advantages of an aortic allograft valve (AAV) over a prosthetic aortic valve, its durability is suboptimal. The aims of the present study were to document characteristic features of AAV dysfunction and to investigate factors influencing the development of such dysfunction. Methods and Results-A group of 570 patients (mean age, 48Ϯ16 years) with a cryopreserved AAV underwent a follow-up echocardiographic study (mean time after surgery, 6.8 years; range, 1.0 to 22.9 years). Significant AAV regurgitation was present in 14.7% of patients, and AAV stenosis was present in 3.2%. The root replacement subgroup had the smallest number of patients with significant AAV regurgitation (5.0%) compared with the subcoronary (23.0%) or the inclusion cylinder technique subgroup (14.7%). After 10 to 15 years after AAV replacement, grade Ն2 AAV dysfunction was present in 40% of patients in the subcoronary subgroup, but no significant dysfunction was observed in patients in the root replacement subgroup (PϽ0.001). Smaller host aortic annulus size in both subcoronary (coefficient, Ϫ0.145; Pϭ0.013) and root replacement subgroups (coefficient, Ϫ0.249; Pϭ0.011) was associated with more frequent AAV dysfunction (grade Ն2). In addition, significant AAV dysfunction was more frequent when patients were younger (coefficient, Ϫ0.020; Pϭ0.015) in the subcoronary subgroup and the donor was older (coefficient, 0.054; Pϭ0.019) in the root replacement subgroup. Conclusions-The present study indicates that the root replacement technique is associated with less frequent AAV degeneration. Our findings should help in establishing more strict selection criteria for surgical replacement procedure type and patient/donor factors for AAV replacement and, therefore, could lead to improve AAV longevity.

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Section: Resultsmentioning

confidence: 99%

Primary Aortic Valve Replacement With Cryopreserved Aortic Allograft

et al. 2002

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“…RRT is easier to perform but reoperations after this technique are difficult. Most authors advocate use of RRT (25,26).…”

Section: Discussionmentioning

confidence: 99%

Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

et al. 2012

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Objective: The aim of this study was to analyze the midterm clinical results of aortic valve replacement with cryopreserved homografts.Materials and Methods: Aortic valve replacement was performed in 40 patients with cryopreserved homograft. The indications were aortic valve endocarditis in 20 patients (50%), truncus arteriosus in 6 patients (15%), and re-stenosis or regurtitation after aortic valve reconstruction in 14 (35%) patients. The valve sizes ranged from 10 to 27mm. A full root replacement technique was used for homograft replacement in all patients.Results: The 30-day postoperative mortality rate was 12.5% (5 patients). There were four late deaths. Only one of them was related to cardiac events. Overall mortality was 22.5%. Thirty-three patients were followed up for 67±26 months. Two patients needed reoperation due to aortic aneurysm caused by endocarditis. The mean transvalvular gradient significantly decreased after valve replacement (p<0.003). The last follow up showed that the 27 (82%) patients had a normal left ventricular function. Conclusion:Cryopreserved homografts are safe alternatives to mechanical valves that can be used when there are proper indications. Although it has a high perioperative mortality rate, cryopreserved homograft implantation is an alternative for valve replacement, particularly in younger patients and for complex surgical problems such as endocarditis that must be minimalized.

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“…Aortic root replacement (ARR) is accepted as the technique of choice for aortic allograft (ALG) or pulmonary autograft (PAG) implantation [1][2][3][4]. However, haemostatic considerations, coupled with desire to prevent the occurrence of secondary graft ring dilatation have prompted the use of reinforcement techniques for the proximal anastomosis [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…However, haemostatic considerations, coupled with desire to prevent the occurrence of secondary graft ring dilatation have prompted the use of reinforcement techniques for the proximal anastomosis [4][5][6][7][8]. This is achieved by incorporating pericardial or fabric strips externally into the proximal suture line [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Pericardial sewing-cuff: an alternative surgical technique for full-root implantation of aortic allograft and pulmonary autograft

Salehi¹,

Aazami²,

Bakshandeh³

et al. 2005

European Journal of Cardio-Thoracic Surgery

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The following is a description of a modified technique for the reinforcement of proximal anastomosis regarding the process of aortic allograft or pulmonary autograft full root implantation. A double width pericardial strip is used to create a pericardial sewing-cuff to be used as a neo-ring. This technique is said to be best suited for decreasing the operative bleeding, reducing anastomotic pitfalls and concomitant repair of the aortic annulus.

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The Aortic Homograft: Evolution of Indications, Techniques, and Results in 107 Patients

Cited by 22 publications

References 16 publications

Primary Aortic Valve Replacement With Cryopreserved Aortic Allograft

Primary Aortic Valve Replacement With Cryopreserved Aortic Allograft

Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

Pericardial sewing-cuff: an alternative surgical technique for full-root implantation of aortic allograft and pulmonary autograft

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