Homograft Aortic Root Replacement

Kim, Jae Hyun; Na, Chan Young; Oh, Sam Sae; Lee, Chang Ha; Baek, Man Jong; Kim, Chong Whan

Abstract

BACKGROUND: Homograft aortic valve replacement (AVR) has many advantages such as excellent hemodynamic performance, faster left ventricular hypertrophy regression, resistance to infection and excellent freedom of thromboembolism. To find out the results of homograft AVR, we reviewed our surgical experiences. MATERIAL AND METHOD: Eighteen patients (male:female=16:2, mean age=39.3+/-16.2 years, range: 14~68 years) who underwent homograft aortic valve replacement between May 1995 and May 2004 were reviewed. The number of homografts was 20 (17 aortic and 3 pulmonic homografts) including two re-operations. Ten patients had a history of previous aortic valve surgery. Indications for the use of a homograft were native valve endocarditis (n=7), prosthetic valve endocarditis (n=5), or Behcet's disease (n=8). The homograft had been implanted predominantly as a full root except in one patient in the subcoronary position. RESULT: Mean follow-up was 41.3+/-26.2 months. There was one operative mortality. Postoperative complications included postoperative bleeding in 3 patients, and wound infection in 1. There was no late death. Three patients underwent redo-AVR. The etiology of the three reoperated patients was Behcet's disease (p=0.025). Freedom from reoperation was 87.5+/-8.3%, 78.8+/-11.2% at 1, 5 years respectively. In patients with infective endocarditis, there was no recurrence of endocarditis. There was no thromboembolic complication.
CONCLUSION
Although longer term follow-up with larger numbers of patients is necessary, the operative and mid-term results for homograft AVR was good when we took into account the operative risks of Behcet's disease or infective endocarditis. Behcet's disease was a risk factor for reoperation after the homograft AVR. We think homograft AVR is the procedure of choice, particularly in patients with infective endocarditis.