Homograft aortic valve replacement--the experience of one unit

Homograft valves offer advantages including avoidance of anticoagulation and less susceptibility to infection especially in the setting of endocarditis. However, there is concern about their durability and possible accelerated degeneration particularly in cases of second time replacement with homografts.

This study aimed to evaluate the pattern of homograft failure and the quality of life in patients after homograft implantation.

Between 1990 and 1998, 58 patients underwent aortic valve replacement with a homograft (aortic homograft = 47, pulmonary homograft = 11). Evaluation was based on clinical and echocardiographic examination, patient questionnaires and explanted valve pathology. Survival and freedom from cardiac related death were expressed by actuarial methods.

Follow up ranged from 1 to 10 years (mean 5.5 years). Analysis of questionnaires revealed 60% of respondents to be in good performance status and 20% in moderate and 20% in poor performance status groups. Eleven patients (18.9%) required subsequent redo valve replacement after initial homograft insertion (pulmonary = 6, aortic = 5) due to either valve dehiscence (n=4) or valve degeneration (n=7). The mean interval of re-replacement was 5.4 years.

Pulmonary homografts have a high failure rate in the aortic position. Overall subjective and clinical improvement after surgery is less than expected for a "physiological" device. In the setting of low availability of homografts the use of off-the-shelf devices such as stentless xenografts may be preferable in most cardiac surgical units in the current era.