AORTIC-VALVE HOMOGRAFTS IN ADULTS - A CLINICAL PERSPECTIVE

Aortic valve replacement is a lifesaving measure in patients with seve re aortic valve disease, In the United States, the most commonly used prostheses are the mechanical and bioprosthetic valves, With mechanica l valves, long-term anticoagulation is necessary because of high throm bogenic potential, Bioprosthetic valves have a relatively high inciden ce of structural failure, especially in younger patients, Aortic valve homografts, derived from human heart donors or autopsy material, prov ide an alternative to mechanical or animal valves, The advantages of t he homograft in comparison with the mechanical prostheses are the low incidence of thromboembolism without anticoagulation and lower valvula r gradients in smaller sizes, Homografts are relatively resistant to e ndocarditis' and are the valve of choice during active endocarditis, T heir major mode of failure has been aortic regurgitation; however, rec ent advances in preservation and operative techniques have decreased t his problem, Whether implantation of an aortic valve homograft should be the procedure of choice in subsets of patients remains controversia l, Herein we review the history, techniques, results, complications, a nd current indications for aortic valve homografts.