Ten-year experience with cryopreserved aortic allografts in the surgical treatment of aortic valve pathologies.

BACKGROUND

The aim of this study was to evaluate the performance of cryopreserved aortic allografts (CAA) in the treatment of adult aortic valve pathologies.

METHODS

Between May 1992 and October 2002, 122 CAA were implanted in 119 adult patients with pathologies of the aortic valve. The mean age of the patients was 38.03 +/- 13.6 years (range 17-78 years). Thirty had had previous cardiac surgery. The principal indication was endocarditis (n = 45). In 66 patients one or more associated pathologies were present including: an abscess of the left ventricular outflow tract (n = 32), an aneurysm of the ascending aorta (n = 22), mitral incompetence (n = 10), and coronary artery disease (n = 3). The indications for surgery were elective in 77 cases and urgent in 45. The CAA was implanted as a total root replacement in 46 patients and as a free-hand in 76. In 66 patients an associated procedure such as a left ventricular outflow tract reconstruction (in 27 cases) was performed.

RESULTS

The in-hospital mortality was 5.73% (7/122). In one patient the CAA was replaced before discharge with another CAA because of a mediastinitis with endocarditis by Candida albicans. At the follow-up of the 114 patients discharged from the hospital (mean 50.11 months, range 1-126 months), 6 patients died and 6 were reoperated. The actuarial 10-year survival, reoperation-free, endocarditis-free, structural degeneration-free rates were respectively 83.88, 81.70, 86.30, and 92.80%.

CONCLUSIONS

From our experience we conclude that CAA are good substitutes for aortic valve replacement and even in desperate situations exhibit an acceptable long-term performance.