"Fresh" aortic allografts: long-term results with free-hand aortic valve replacement

Renewed interest in the use of "fresh" and cryopreserved allograft valves for aortic valve replacement (AVR) prompted an updated analysis of the long-term results of our old experience (1964-1971) with free-hand AVR. Eighty-three patients received "fresh" (antibiotic stored at 4 degrees C for intervals between 24 hrs and 18 days), free-hand allograft valves. Current (1986) follow-up was 96% complete; cumulative follow-up included 773 patient-years (pt-yr) and averaged 9 yrs. Importantly, 37 patients were still at risk with their original allograft valve at ten yrs, and 12 patients at 17 yrs. Standard conservative criteria were used to assess valve-related complications. Thromboembolism (TE) occurred at a linearized incidence of 1.0%/pt-yr, anticoagulation-related hemorrhage (ACH) at 0.2%/pt-yr), and fatal prosthetic valve endocarditis (PVE) at 0.5%/pt-yr. In actuarial terms, the incidence of degenerative valve failure was 30 +/- 6% (+/- SEM) at ten yrs and 40 +/- 7% at 15 yrs. Valve failure due to all causes (including sudden, unexplained deaths and PVE) occurred in 38 +/- 6% of patients at ten yrs and 57 +/- 7% after 15 yrs. The incidence of fatal valve failure was 11 +/- 4% at six yrs (the time of the last event). The rate of reoperation was 33 +/- 6% at ten yrs and 52 +/- 7% at 15 yrs. Given the relatively crude methods of allograft valve preparation and storage during this remote era, we believe that these long-term results with free-hand allograft AVR are satisfactory, albeit far from optimal.(ABSTRACT TRUNCATED AT 250 WORDS)