[Homograft replacement of aortic valve and ascending aorta]

From May 1990 through December 1994, integral valved aortic homografts were implanted for replacement of the aortic valve and of part or the whole of the ascending aorta in 24 patients with a mean age of 45.5 years (17-66 years). Ten patients (41.7%) had infective endocarditis of the aortic valve (4 of the native valve and 6 prosthetic). Seven of these had root abscesses (70%), one with a fistula to the right atrium, resulting in a variable degree of discontinuity between the left ventricle and the aorta. Twelve patients (50%) had ascending aortic aneurysms and the remaining two (8.3%) had aortic dissection. Three patients (12.5%) also had mitral pathology, one had triple vessel coronary disease, one had aortic coarctation and another one had a sub-aortic membrane. Two thirds of the patients were in NYHA class III/IV and 10 (41.7%) had moderate or severe left ventricular dysfunction. A modified Bentall technique utilising fresh aortic homografts was used in all patients. The homografts were harvested aseptically from donors with a mean age of 30 years (16-54 years) and preserved at 4 degrees C for a period of 1-43 days (median-13 days). Six patients (25%) had associated surgery: mitral valve replacement; mitral valvuloplasty with a ring; closure of aortic- atrial fistula, resection of sub-aortic membrane; triple coronary artery bypass; and mitral and tricuspid annuloplasty and closure of ASD (one patient each). Postoperatively three patients (12.5%) required reexploration for excessive blood drainage in the first hours and one patient with complete A-V block required a pacemaker (4.2%). Hospital mortality was 4.2% (one patient). At the time of discharge, no patient had significant Doppler or echocardiographic aortic gradient or regurgitation. All patients were followed for a mean period of 31 months (7-62 months). One patient died of a non cardiac death and the remainder are in NYHA class I without thromboembolic or haemorrhagic accidents and with echocardiographic findings similar to those observed at discharge. These results suggest that aortic homografts constitute an effective and safe method of reestablishing the continuity between left ventricle and aorta, especially in the presence of an infective process with root abscesses.