Aortic homografts versus mechanical valves in aortic valve replacement in young patients: A retrospective study

Background. Whether aortic homografts (AH) or mechanical devices (MD) are t he valves of choice for aortic valve replacement in young patients (age 20 to 50 years) is unclear. Hence, we examined all aortic valve replacements p erformed with AH and MD in a retrospective study. Methods. Between 1988 and 1995, 45 patients (mean age, 38.6 +/- 8.5 years) underwent aortic valve replacement with an AH and 40 patients (mean age, 42 .0 +/- 7.2 years) with an MD. Patients' demographic data were comparable in all respects, except acute endocarditis, which was an absolute indication for the use of an AH. Results. The mean follow-up time was 51.7 +/- 22.6 months for AH versus 44. 6 +/- 26.9 months for MD (not significant). There were significant differen ces in postoperative outcome among the two groups (p less than or equal to 0.05): perioperative death (4 versus 0 for AH and MD, respectively); reoper ation (8 for AH versus 0 for MD); and endocarditis (5 versus 0 for AH and M D). There were higher incidences of embolism (2 versus 0) and hemorrhage (2 versus 0) in MD compared with AH. Only late death was comparable among the two groups with 5 patients in each group. Conclusions. The mechanical valves in our midterm follow-up are superior to homografts. However, embolic and hemorrhagic complications in MD are conti nuously impending and cumulative during a long-term followup. The surprisin gly high rate of endocarditis in the AH group is only partly caused by the indication: 2 cases were recurrent, but there were also 2 new onsets of end ocarditis. In 4 cases structural deterioration was responsible for reoperat ion. Aortic valve replacement with aortic homografts showed a rather unfavo rable midterm outcome in this selected group of young patients. A surprisin gly high rate of graft endocarditis and structural deterioration led to sub sequent reoperations. Although our results with mechanical valves are satis fying, embolism and hemorrhage are impending risk factors for many years to come in these young patients. (C) 1998 by The Society of Thoracic Surgeons .