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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft
Satsuki Fukushima1, Peter J Tesar1, Bronwyn Pearse1
1Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Australia.
The Journal of Thoracic and Cardiovascular Surgery
|September 12, 2013
Summary
Cryopreserved aortic allografts show durability exceeding 15 years for most patients. Structural deterioration is linked to recipient age, donor age, obesity, and implantation technique, guiding future strategies for biological valve substitutes.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Transplantation Immunology
Background:
- Increasing use of biological valves for aortic valve disease faces challenges with structural deterioration.
- Cryopreserved aortic allografts offer a potential solution, but their long-term durability requires further investigation.
- Understanding allograft failure mechanisms is crucial for improving biological valve substitutes.
Purpose of the Study:
- To evaluate the long-term durability of cryopreserved aortic allografts.
- To identify factors contributing to structural deterioration of aortic allografts.
- To inform strategies for preventing or treating biological valve substitute failure.
Main Methods:
- Review of 840 cryopreserved aortic allografts implanted over 35 years.
- Clinical follow-up in 99% of cases, with data on explantation and mortality.
- Statistical analysis to identify independent predictors of structural deterioration.
Main Results:
- Allografts demonstrated durability beyond 15 years, with a median time to structural deterioration of 20 years.
- Factors associated with structural deterioration include young recipient age, elderly donor age, recipient obesity, prior blood transfusion, and full-root implantation.
- Infection was rare, and reintervention had a 2% in-hospital mortality rate.
Conclusions:
- Cryopreserved aortic allografts are durable, lasting over 15 years for many patients.
- Recipient and donor age, recipient obesity, transfusion history, and implantation technique significantly influence allograft durability.
- These findings highlight key factors to consider for optimizing the performance and longevity of biological heart valves.
