[Aortic valve replacement using aortic donor valves of human origin].

OBJECTIVE

To evaluate the experiences of aortic valve replacement with cryopreserved aortic allografts in the subcoronary position.

DESIGN

Descriptive clinical study.

SETTING

Thorax Centre of Rotterdam University Hospital.

METHOD: In the period July 1988-March 1993, 68 patients (45 men and 23 women) with a mean age of 45 years underwent 69 operations. One woman was operated twice. Main criteria for aortic valve replacement by an allograft were age and endocarditis. The pathology leading to aortic valve dysfunction had been: endocarditis (38%), congenital lesions (32%), rheumatic lesions (19%), senile degeneration (7%), paravalvular leakage (3%) and an active autoimmune disease (1%).

RESULTS

Hospital mortality was 4%. The mean follow-up was 22 months, with a cumulative follow-up of 126 patient years. One patient died of lung cancer during this period. Six patients needed a second operation (9%); 4 of these were among the first 15 patients operated on. One of these reoperations was necessary to treat a recurrent endocarditis. Only one other late valve-related event took place: a transient ischaemic attack 2 years postoperatively. Ninety-one per cent of the patients with an allograft in situ were in NYHA class I at their last outpatient clinic visit. The other patients were in class II. Pre-cordial color Doppler echocardiography showed no or mild aortic regurgitation in 95% of these patients. The remaining 3 patients had moderate aortic regurgitation.

CONCLUSION

Aortic valve replacement with an allograft was performed with low hospital mortality. The expected advantages are greatest in young patients and patients with endocarditis; these patients, therefore, should have priority in allograft allocation.