Long-term results of valve replacement using antibiotic-sterilised homografts in the aortic position

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Abstract
OBJECTIVE: Antibiotic-sterilised homograft valves stored at 4 degrees Chave been implanted in the subcoronary position in this unit since 1973.This study was undertaken in order to assess the long-term function ofthese valves. METHODS: All 249 patients undergoing homograft aortic valvereplacement (AVR) at the Wessex Cardiothoracic Centre between April 1973and December 1994 were studied. Homograft valve sizes ranged from 15 mm to28 mm internal diameter, 202 (81.1%) varying between 18 mm and 22 mm. Themean patient follow-up was 12.4 years with a total follow-up of 3096patient-years. There were six early deaths (2.4%). RESULTS: On actuarialanalysis, survival was 78.5+/-2.7% (1SE) at 10 years, 65.7+/-3.3% at 15years and 55.0+/-3.9% at 20 years. The freedom from redo AVR was87.9+/-2.4% at 10 years, 71.7 +/-3.8% at 15 years and 49.7+/-5.6% at 20years. The freedom from structural degeneration was 85.6+/-2.5% at 10years, 63.6+/-4.0% at 15 years and 41.9+/-6.4% at 20 years. On multivariateanalysis the risk of valve failure was significantly higher in youngerpatients (P<0.0001) and in those who underwent aortic root tailoring (P= 0.024). The freedom from endocarditis was 98.4+/-0.9% at 10 years,96.2+/-1.6% at 15 years and 95.1+/-1.9% at 20 years. Of the 249 patients,218 had an isolated homograft AVR and were not anticoagulated. In thisgroup there were two possible thromboembolic events. CONCLUSION: As well asthe established haemodynamic benefits, this study has shown that homograftAVR with antibiotic-sterilised 4 degrees C stored homograft valvesimplanted in the subcoronary position, offers good long-term results.

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