Patient outcome and valve performance following a second aortic valve homograft replacement

Background-Homograft valves offer many advantages; however, there is concer n about their use in second aortic valve replacement because of the complex ity of the procedure and the possibility of accelerated degeneration, Methods and Results-One hundred and forty-four patients underwent a second aortic homograft replacement between 1973 and 1997 (mean follow-up 6.5+/-5 years, range 1 to 20 years). Eighty-three were mole, and 61 were female, ag ed 17 to 77 years, mean 49.0 years. All patients had undergone previous aor tic valve replacement with a homograft. The indication for reoperation was aortic regurgitation in 75 patients (52.1%), aortic stenosis in 28 (19.4%), and mixed aortic valve disease in 41 (28.5%). Root replacement was perform ed in 54 patients (38%) and subcoronary in 90 (62.5%). Early mortality was 3.4%. The actuarial survival rate was 93% and 82% at 5 and 10 years, respec tively. Freedom from tissue degeneration was 96% and 80% at 5 and 10 years, respectively, and freedom from reoperation was 97% and 82% at 5 and 10 yea rs, respectively. Conclusions-This study shows that a second aortic valve homograft replaceme nt results in good early and long-term survival. Accelerated degeneration d oes not occur. Left ventricular performance is improved, and earlier surger y could further improve outcome, indicating that an aortic homograft is a s afe, durable option for patients requiring a second aortic valve replacemen t.