Aortic valve homograft: 10-year experience.

The first aortic valve homograft was implanted by Sir Donald Ross in 1962. Since then, over 25,000 aortic homografts have been implanted worldwide. Unfortunately, the current cryopreservation method promotes a degenerative process leading to progressive homograft fibrosis and calcification. Valve durability of fresh allografts appears to be superior to cryopreserved grafts. The main indications of aortic valve replacement with a homograft are endocarditis, rheumatic disease, bicuspid and dystrophic aortopathies. Our experience with 210 aortic homografts implanted over a 10-year period is reported. We describe the different implantation techniques with particular emphasis on the current technique of choice, namely homograft root replacement. Approximately one-fourth of all aortic homografts will experience structural valve deterioration at 12 years. Structural homograft valve deterioration translates predominately into valve insufficiency and less frequently into stenosis. Young recipient age it appears is the major determinant of reoperation. Predictors of early and late mortality are discussed.