Homograft replacement of single aortic valve cusps: 22 years follow-up

Single aortic valve cusp replacement with fresh aortic homografts were performed in four patients from November 1966 to April 1970. All had preoperative aortic insufficiency due to destruction of a single cusp, with the remaining two cusps structurally and functionally intact. Replacement was performed using the noncoronary cusp from fresh aortic valve homografts. Patient one had homograft cusp replacement of the left coronary cusp at age 13 due to bacterial endocarditis. She recently underwent mitral valve replacement; study and inspection of the aortic valve showed it to be structurally and functionally intact 22 years following homograft cusp replacement. Patient two sustained a gunshot wound perforating his right coronary cusp. He underwent single cusp replacement in January 1967. Currently, he is asymptomatic and has been without evidence of significant aortic valve dysfunction for the past 21 years. Patient three had destruction of the noncoronary cusp due to endocarditis and had homograft cusp replacement in October 1967. Four and a half years later he developed recurrent endocarditis, presented with severe congestive heart failure due to aortic insufficiency, and died. Patient four had bacterial endocarditis affecting the right coronary cusp and had replacement in April 1970. In February 1980, he underwent aortic valve replacement for aortic stenosis. Inspection revealed calcification of the other two cusps with the homograft cusp structurally normal. In summary, follow-up of homograft replacement of single aortic valve cusps from 4 1/2 to 22 years, shows it to be a durable and feasible alternative to prosthetic valve replacement.