THE USE OF UNSTENTED HOMOGRAFT VALVES FOR AORTIC-VALVE REOPERATIONS -REVIEW OF A 23-YEAR EXPERIENCE

Unstented homograft valves offer several theoretical advantages when u sed for patients who have had previous operations on the aortic valve. Between January 1970 and February 1993, 177 patients received unstent ed homograft valves after previous aortic valve operations. One hundre d thirty-four patients had previous aortic valve replacement in the fo rm of homografts (101 patients), mechanical prostheses (24 patients), and bioprostheses (9 patients), and 43 had previous valve repair. The indication for reoperation was deterioration of a noninfected valve (1 24 patients), infective endocarditis (40 patients), and failure of a n oninfected mechanical valve (12 patients). Fresh homograft valves were implanted in 60 patients, homografts preserved in antibiotics were us ed in 111 patients, and 6 patients received cryopreserved valves. Aort ic valve and root replacement was performed in 60 patients, and in 117 the homograft was inserted freehand in the subcoronary position. The early mortality was 5.1%. The actuarial survival at 10 years was 71%; Multivariate analysis demonstrated that patients with previous homogra ft replacement have a better long-term survival than patients who had previous mechanical valves (p = 0.017). The freedom from valve-related death and reoperation was 70% at 10 years. Fresh homografts faired be tter than antibiotic-sterilized homografts (p = 0.007). None of the pa tients had recurrence of endocarditis at 6 months, although 1 patient died of uncontrolled infection despite valve replacement. The freedom from recurrent endocarditis was 88% at 10 years. We conclude that unst ented aortic homografts provide good early and long-term results for a ortic valve reoperations, particularly in patients with previous homog raft replacement. Recurrent endocarditis is uncommon even in patients operated on for prosthetic valve infections.