THE PULMONARY HOMOGRAFT AS AORTIC-VALVE SUBSTITUTE - 7 YEARS FOLLOW-UP

Objective: The advantages of the aortic valve homograft-high resistanc e to infective endocarditis, low risk of thromboembolism, low gradient and excellent long term results are well known. Trying to extend thes e advantages to a greater number of patients, we used pulmonary homogr afts as aortic valve substitute, based on the experimental evidence, t hat they can withstand the higher stress in systemic circulation. Meth ods: From September 1988 to August 1994 175 patients (103 men, 72 wome n, mean age 61.75 +/- 12.92 years) underwent aortic valve replacement with a cryopreserved pulmonary homograft. All valves were taken from o ur own homograft bank. They were inserted freehand intraaortically, 16 2 in subcoronary position, 13 as intraaortic cylinder. All patients we re followed clinically and by colorflow Doppler echocardiography in 3- 12 month intervals. Results: Patients, 8, died perioperatively (4.57%) . None of the deaths was valve related. Patients, 2, had to be reopera ted during the perioperative period due to severe valvular incompetenc e 165 patients were followed up to a period of 7.5 years (mean interva l 3.83 +/- 1.45 years). Patients, 30, died, 13 deaths (7.42%) must be regarded as valve related. Patients, 22, (12.52%) had to be reoperated due to severe graft incompetence. Patients, 9 (5.14%), acquired prost hetic endocarditis. Conclusion: Due to our results, high rate of valve related deaths, high rate of graft failure and high rate of prostheti c endocarditis, we must state that the. pulmonary homograft did not fu lfil our expectations and presently we can not recommend it as an aort ic valve substitute. (C) 1997 Elsevier Science B.V.