4. ISOLATED AORTIC VALVE REPLACEMENT IN ADULTS COMPARISON OF LATE OUTCOME BETWEEN THE ROSS OPERATION AND CRYOPRESERVED HOMOGRAFTS
Christopher J. Knott-Craig*, Ronald C. Elkins*, KathyLee Santangelo, Carolyn McCue, Mary M. Lane
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, USA
BACKGROUND
Autograft (AG) and homograft (HG) are currently considered the best choices for replacement of the diseased aortic valve in adults, although few data exist comparing their late outcome. Nonhomogeneous populations and evolving operative techniques confound existing comparisons. To help clarify these issues, we reviewed our results with 238 hospital survivors (17-82 yrs) undergoing operation between 1986 and 1999. All surgeries were done as root replacements, and patients needing concomitant valve replacement were excluded.
MATERIAL AND METHODS
Mean ages of the 145 AG and 106 HG patients were 35
± 12 yrs and 49± 16 yrs respectively (P<0.01). Diameters of the AGs and HGs was 25± 1 mm and 22± 1 mm respectively (P<0.01). Concomitant coronary bypass surgery was done in 14 HG and nine AG patients. Aortic root was tailored in 61 AG and four HG patients, and a proximal suture line was reinforced in 113 and 20 respectively (P<0.01). Maximum follow-up was 11.5 yrs for AG and 12.8 yrs for HG patients. Late survival at 10 yrs was 74± 15% for AG and 66± 13% for HG patients (P=0.12). Freedom from valve-related complications at 10 yrs was 86± 8% and 68± 14% respectively (see figure). Freedom from AG or HG degeneration at 10 yrs was 96± 3% and 68± 14% (P=0.16).(graph )
RESULTS AND CONCLUSION
Patients with AG and HG have comparable late survival. Valve-related complications in AG patients often relate to the homograft in the pulmonary position, whereas HG patients may start deteriorating after about 8-10 yrs, suggesting benefit of AG over HG for the younger patient.
