Aortic valve replacement with biological substitute

In the quest for an ideal aortic valve substitute, homografts and autograft s are well-established options. We reviewed our results with homografts and autografts for aortic valve replacement during the last 5 years. From Marc h 1992 through July 1997, 189 patients (138 male and 51 female), age 8 mont hs to 68 years (mean 31.0 +/- 4.2 years), underwent aortic valve replacemen t with a human biological substitute. Of these, 93 patients received a cryo preserved or antibiotic-preserved aortic/pulmonary homograft, whereas 96 pa tients underwent a Ross procedure. Etiology was rheumatic in 143 (75.6%) pa tients, bicuspid aortic valve in 40 (21.2%), Marfan's disease in 5 (2.6%), and myxomatous aortitis in 1 (0.5%). Among the homograft group, a scalloped subcoronary implantation technique was used in 54 patients, whereas 32 pat ients underwent root replacement. Five patients required aortic root, and a scending aortia replacement for annuloaortic ectasia. In all patients under going the Ross procedure, a root replacement technique was used. Operative mortality was 7.4% (14 patients). Late mortality was 5.3% (10 patients). Fo llow-up ranged from 1 to 46 months postoperatively. In patients with homogr aft aortic valve replacement, 76 patients (91.5%) had trivial to mild aorti c regurgitation, while 7 patients (8.4%) had important aortic regurgitation . In patients with the Ross procedure, 78 patients (89.6%) had trivial to m ild regurgitation. Moderate to severe aortic regurgitation was present in 9 patients (10.3%), all of whom had rheumatic heart disease and were young ( < 30 years at surgery). We conclude that homografts and autografts provide an excellent substitute for the diseased aortic valve. Young age (< 30 year s) with rheumatic etiology is a major risk factor for early progressive aor tic regurgitation in patients undergoing the Ross procedure.