Allograft aortic valve replacement. A comparison of the free-hand technique versus aortic root replacement

Comparing the results of aortic valve replacement (AVR) with cryopreserved allografts using two operative techniques: the free-hand and aortic root replacement.

A cohort study in a tertiary care center.

Fifty eight patients underwent allograft AVR during the years 1987-1994. The free-hand technique was used in 40 patients (group A) and aortic root replacement in 18 (group B).

Perioperative morbidity, mortality, blood transfusion requirement and length of hospital stay. Mid-term survival, functional class and valve related complications.

Early mortality-2 patients (11%) in group B, none in group A (p = 0.09). Patients in group B received more donor exposure from blood products than group A (28.4 +/- 29.8 donors versus 3.8 +/- 6.1 donors, p < 0.00001). Perioperative complications occurred more often in group B (p = 0.042). However, the length of hospital stay was similar. Long-term follow-up ranged from 1 to 73 months (median 43 months). There was one non-valve related late death. No recurrence of endocarditis, or thromboembolic events were observed. 96% of the patients were in NYHA class I or II. Of these, echocardiogram showed trace or no aortic regurgitation (AR) in 96%. In group A one allograft was rereplaced with a mechanical valve for a technical failure, and mild and moderate AR were documented in two patients. This was not significantly different from group B.

Aortic allograft durability at 6 years is excellent and the overall valve-related complication rate is extremely low. The differences between the two groups were too small to demonstrate a clear-cut superiority to any of the techniques. However, our results suggest that aortic root replacement is associated with increased early morbidity and mortality when used for more complex aortic valve and aortic root pathology, whereas the free-hand technique may be associated with more mid-term valvular insufficiency.