FREEHAND SUBCORONARY AORTIC-VALVE AND AORTIC ROOT REPLACEMENT WITH CRYOPRESERVED HOMOGRAFTS - INTERMEDIATE-TERM RESULTS

Background and aims of the study: The traditional method of aortic val ve replacement with a homograft has been free-hand insertion in the su bcoronary position. Recently, total root replacement has become increa singly popular. We present our experiences with both methods in this s tudy. Material and methods: Between January 1, 1987 and March 31, 1996 , 208 patients underwent homograft replacement of the aortic valve (fr ee-hand subcoronary technique, n = 147 and root replacement, n = 61). The age of the patients ranged between 1.5 and 78 years with a mean ag e of 41 years. There were 55 females and 153 males, Ninety-four patien ts had infected aortic root (with 47 ring abscesses) and 114 patients had sterile aortic roots. In these series, patients with small aortic root, complicated endocarditis, dilated aortic annulus and aneurysm re ceived aortic root replacement. Results: The hospital mortality of pat ients with noninfected and infected roots was 2.6% and 8.5% respective ly making an overall hospital mortality of 5.2%. In patients with free -hand subcoronary valve implantation (AVR) and root replacement (ARR) techniques the hospital mortality was 3.4% and 9.8% respectively. The major risk factor for death was New York Heart Association functional class IV with sepsis. Eight years patient survival in patients with AV R and ARR was 95% +/- 2% and 86% +/- 4% respectively. Freedom from str uctural deterioration in patients with AVR and ARR was 96.5% +/- 2% an d 98% +/- 3% whereas freedom from reoperation was identical 94% +/- 2% and 93% +/- 4% respectively. However, the incidence of reoperation in patients under 40 years of age, particularly in children (<16 years o f age) during the eight years' follow up was 27%, The rate of recurren t endocarditis was 3.6% in ARR patients and development of postoperati ve pseudoaneurysm formation occurred in 1.4% of AVR patients with endo carditis. Conclusion: In conclusion, ARR technique provides low rate o f reoperation in the early postoperative period. Cryopreserved homogra fts in the subcoronary position in adult patients <40 years of age sho wed excellent medium term durability and hemodynamic performance provi ding evidence that long term outcome with a meticulous subcoronary imp lantation technique is comparable to that with the ARR technique.