The Annals of thoracic surgery · 2005
Valve-related events after aortic root replacement with cryopreserved aortic homografts.
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Kaya Abdullah, Schepens Marc A, Morshuis Wim J, Heijmen Robin H, Brutel de la Riviere Aart, Dossche Karl M
Аннотация
BACKGROUND: Aortic root replacement with aortic homografts for various pathologic conditions involving the aortic root has yielded good early results. To assess mid-term valve-related events, a follow-up study was conducted.
METHODS: From February 1989 through January 2003, 213 patients with a mean age of 51.3 +/- 11.8 years underwent aortic root replacement with a cryopreserved aortic homograft. Bacterial endocarditis (58.7%) was the predominant indication for surgery (native valve endocarditis, n = 73; prosthetic valve endocarditis, n = 52). Of the 197 hospital survivors, 194 were entered in the follow-up study (98.5% complete). Endpoints of the study were death, valve-related death, reoperation for valve failure, endocarditis, thromboembolic events, and anticoagulant-related bleeding events. Follow-up was conducted between February and April 2003.
RESULTS: Overall hospital mortality was 7.5% (n = 16; 70% confidence limits, 5.6% to 9.4%). Mean follow-up was 5.8 years (range, 0.3 to 14.3). In total, 20 late deaths occurred (10.3%); of these, 5 were valve-related. The overall survival at 5 and 10 years is 87.3% +/- 2.4% and 70.8% +/- 5.3%, respectively. Twenty-one patients (10.8%) required reoperation, either for structural valve deterioration (n = 12), false aneurysm (n = 3), endocarditis of the homograft (n = 3), or for other reason (n = 3). Mortality for reoperation was 28.6% (n = 6). Five-year and 10-year freedom from reoperation is 94.5% +/- 1.8% and 76.4% +/- 5.3%, respectively. Endocarditis of the homograft was reported in 4 patients (3.2%), of whom 1 patient was treated medically and 3 required reoperation. Thromboembolic events (n = 1) and anticoagulant-related bleeding events (n = 0) were rarely seen. A recent echocardiographic study was available in 124 patients (71.3%). Aortic regurgitation grade I to II was reported in 121 patients (97.6%).
CONCLUSIONS: Cryopreserved aortic homografts function well on mid-term evaluation. The incidence of structural valve failure is acceptable. Reoperations for homograft endocarditis carry a high mortality rate.
METHODS: From February 1989 through January 2003, 213 patients with a mean age of 51.3 +/- 11.8 years underwent aortic root replacement with a cryopreserved aortic homograft. Bacterial endocarditis (58.7%) was the predominant indication for surgery (native valve endocarditis, n = 73; prosthetic valve endocarditis, n = 52). Of the 197 hospital survivors, 194 were entered in the follow-up study (98.5% complete). Endpoints of the study were death, valve-related death, reoperation for valve failure, endocarditis, thromboembolic events, and anticoagulant-related bleeding events. Follow-up was conducted between February and April 2003.
RESULTS: Overall hospital mortality was 7.5% (n = 16; 70% confidence limits, 5.6% to 9.4%). Mean follow-up was 5.8 years (range, 0.3 to 14.3). In total, 20 late deaths occurred (10.3%); of these, 5 were valve-related. The overall survival at 5 and 10 years is 87.3% +/- 2.4% and 70.8% +/- 5.3%, respectively. Twenty-one patients (10.8%) required reoperation, either for structural valve deterioration (n = 12), false aneurysm (n = 3), endocarditis of the homograft (n = 3), or for other reason (n = 3). Mortality for reoperation was 28.6% (n = 6). Five-year and 10-year freedom from reoperation is 94.5% +/- 1.8% and 76.4% +/- 5.3%, respectively. Endocarditis of the homograft was reported in 4 patients (3.2%), of whom 1 patient was treated medically and 3 required reoperation. Thromboembolic events (n = 1) and anticoagulant-related bleeding events (n = 0) were rarely seen. A recent echocardiographic study was available in 124 patients (71.3%). Aortic regurgitation grade I to II was reported in 121 patients (97.6%).
CONCLUSIONS: Cryopreserved aortic homografts function well on mid-term evaluation. The incidence of structural valve failure is acceptable. Reoperations for homograft endocarditis carry a high mortality rate.