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Aortic valve replacement with cryopreserved aortic allograft: ten-year experience
J R Doty1, J D Salazar, J R Liddicoat
1Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md, USA.
The Journal of Thoracic and Cardiovascular Surgery
|February 25, 1998
Summary
Cryopreserved aortic allografts offer excellent long-term results for aortic valve replacement, showing low mortality and reoperation rates. Patients experience improved functional status with minimal valve incompetence and rare complications like thromboembolism or endocarditis.
Area of Science:
- Cardiovascular Surgery
- Transplantation Immunology
- Biomaterials Science
Background:
- Cryopreserved aortic allografts are viable options for aortic valve replacement across various etiologies.
- Allograft use is particularly considered for younger patients and in cases of active bacterial endocarditis.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of aortic valve replacement using cryopreserved aortic allografts.
- To assess patient outcomes, including mortality, functional status, and valve-related complications.
Main Methods:
- A cohort of 117 patients underwent aortic valve replacement with cryopreserved aortic allografts between July 1985 and August 1996.
- Four distinct surgical techniques were employed, and valve function was assessed intraoperatively and postoperatively via echocardiography.
Main Results:
- 118 allografts were implanted with a mean follow-up of 4.6 years (up to 11 years).
- Excellent functional status (94% NYHA class I) was observed, with 90% demonstrating no or trivial postoperative aortic regurgitation.
- Ten-year freedom from valve-related mortality was 93%, from thromboembolism 100%, and from endocarditis 98%. Freedom from reoperation for allograft-related causes was 92%.
Conclusions:
- Aortic valve replacement with cryopreserved aortic allografts is associated with low perioperative and long-term mortality.
- The procedure yields excellent functional outcomes and demonstrates superior freedom from thromboembolism, endocarditis, and progressive valve incompetence.
- Reoperation for allograft-related issues is infrequent, highlighting the durability of cryopreserved aortic allografts.