Long-term results after aortic valve replacement in patients with congestive heart failure - Homografts vs prosthetic valves

Objectives The aim of this study was to assess the influence of valve subst itute (homograft vs prosthetic valve) on the long-term survival and late va lve-related complication rates following aortic valve replacement in patien ts with aortic valve disease and congestive heart failure. Background The effect of choice of valve substitute on outcome after aortic valve replacement in patients with pre-operative heart failure is unknown. The superior haemodynamic profile of homografts may be of particular benef it. Methods We retrospectively analysed pre-operative, operative and follow-up data on 518 adults in functional classes III and IV, who, over the 25 years 1969-1993, had their initial aortic valve replacement at Harefield hospita l. Follow-up conducted during 1996 to April 1997 and totalling 4439 patient -years was 96.1% complete. Using multivariate analysis, independent risk fa ctors for different complications and mortality were defined. Results Overall 5-, 10- and 20-year survival was 80 +/- 2%, 62+/-2% and 30/-3%, respectively, with no significant difference between valve types. How ever, homografts (n=381) independently reduced the rate of serious complica tions and cardiac death, whereas mechanical valves were an independent adve rse risk factor for late mortality. The rates of anticoagulant-related blee ding and thromboembolism were increased by mechanical valves, whereas prima ry tissue failure was the main complication of homografts. Conclusions Long-term outcome of homograft aortic valve replacement in pati ents with congestive heart failure is acceptable, with a reduced rate of se rious complications and cardiac death. Further improvements would be expect ed if the rate of primary tissue failure could be reduced. (C) 2000 The Eur opean Society of Cardiology.