Cryopreserved aortic allografts for aortic root reconstruction: A single institution's experience

Background. An evaluation of early and long-term results of aortic root rep lacement with cryopreserved aortic allografts and echocardiographic follow- up of allograft valve function was performed. Methods. From September 1989 through May 1998, 132 patients aged 17 to 77 y ears (mean, 50.8 +/- 14.8 years) underwent freestanding aortic root replace ment with a cryopreserved aortic allograft. Eighty-six (65.1%) patients had New York Heart Association class III or IV functional status before operat ion, and 27 (20.5%) patients underwent emergency operation. Fifty-nine (44. 7%) patients had undergone previous cardiac operations. The cause of aortic disease was acute endocarditis in 63 (47.7%) patients, healed endocarditis in 15 (11.3%), degenerative in 20 (15.2%), congenital in 20 (15.2%), faile d prosthesis in 10 (7.6%) and rheumatic in 4 (3.0%). Follow-up was complete , with a mean of 42 months. Results. There were 12 hospital deaths (9.1%; 70% confidence limits [CL], 6 .6% and 11.6%); 9 of them were operated on for active endocarditis (p = 0.0 62). Multivariate analysis determined age older than 65 years (p 0.012) and emergency operation (p = 0.009) as independent risk factors for hospital m ortality. During followup, 6 (5.0%; 70% CL, 3.0% and 7.0%) patients died. C umulative survival rate for the entire group was 81.8% +/- 5.4% at 8 years. Freedom from reoperation for structural valve failure was 100%, freedom fr om reoperation for any cause was 96.3% +/- 1.8% at 8 years. Freedom from en docarditis at 8 years was 97.9% +/- 1.4%. Follow-up of allograft valve func tion showed no or trivial aortic regurgitation in 97% of patients and absen ce of stenosis of the allograft in 100%. Conclusions. Aortic root replacement with cryopreserved aortic allografts c an be performed with acceptable hospital mortality and long-term results. T he durability of cryopreserved aortic allografts is good, and reoperation f or structural valve failure is absent at 8 years. (C) 1999 by The Society o f Thoracic Surgeons.