Six year review of the results of freehand aortic valve replacement using an antibiotic sterilized homograft valve.

Abstract

The long-term behavior of an antibiotic-treated homograft aortic valve inserted in a freehand fashion was assessed in 121 patients operated upon for aortic valve disease and followed from 4-6 1/2 yr. There were 7 hospital deaths (5.7%) and 30 late deaths, only 1 of which was related to the homograft valve. The 6 yr survival was 69% (77% for single valve and 52% for multiple valve surgery). At 6 yr 9% had important homograft aortic valve incompetence (HAVI) and most of these required reoperation. Important HAVI occurred in only 5% of patients with an aortic root diameter < 24 mm and in 38% of those with a markedly dilated or distorted proximal aorta (P < 0.01). The freehand aortic homograft was considered superior to prosthetic devices because of the absence of chronic anticoagulation, thromboembolism, sudden death from valve failure and significant obstruction in a small aortic root. With slightly restricted patient selection the valve failure rate is expected to fall to less than 1%/yr.