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      Homograft implantation for aortic valve replacement since 15 years: results and follow-up.

      The heart surgery forum
      Adolescent, Adult, Aged, Aged, 80 and over, Aortic Valve, microbiology, transplantation, Aortic Valve Insufficiency, surgery, ultrasonography, Cardiac Surgical Procedures, adverse effects, mortality, Child, Echocardiography, Female, Follow-Up Studies, Hemodynamics, Humans, Infection, etiology, Kaplan-Meier Estimate, Male, Middle Aged, Postoperative Complications, Postoperative Period, Prospective Studies, Reoperation, statistics & numerical data, Time Factors, Transplantation, Homologous, Young Adult

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          Abstract

          The use of homografts in aortic valve replacement is an alternative to other prostheses and has been established in our department for 15 years. Since 1992, 360 homografts (HG) have been implanted in adult patients (mean age 51.6 years, 72.8% male). Prospective follow-up was done on an annual basis. Thirty-day mortality was 5.0% (n = 17); after 5, 10, and 15 years, survival was 88.3%, 84.6%, and 76.0%, respectively. Out of 39 late deaths, 11 were valve-related (10 HG infections, 1 aortic aneurysm). Freedom from reoperation was 99.4% 1 year after operation; after 5, 10, and 15 years it was 94.1%, 78.2%, and 67.3%, respectively. Indications for HG explantation were graft infections (n = 20), calcification (n = 16), regurgitation > grade II (n = 17), perforation (n = 8), and paravalvular leakage (n = 1). Eleven transitoric ischemic attacks, 2 strokes, and 1 cerebral bleeding event were recorded. In echocardiography, the transvalvular pressure gradient changed from 10.55 to 15.02 (P = .004), 19.9 mmHg (P = .056), and 37 mmHg (not applicable) after 5, 10, and 15 years, respectively. Mean HG regurgitation was grade 0.49 before discharge and increased to 1.0 (P < .001), 0.91, and 2.5 after 5, 10, and 15 years, respectively. Ejection fraction increased from 61.9% to 64% after 5 years and to 66% after 10 years (P = .021) and then decreased to 63.5% after 15 years. Comparing HG with other valve prostheses, survival and graft durability seem to be confirmed. They are vulnerable to infections. The hemodynamic performance is good, and hemorrhagic or thrombo-embolic events are rare.

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