Ten-year experience with cryopreserved aortic allografts in the surgical treatment of aortic valve pathologies.

BACKGROUND: The aim of this study was to evaluate the performance of cryopreserved aortic allografts (CAA) in the treatment of adult aortic valve pathologies. METHODS: Between May 1992 and October 2002, 122 CAA were implanted in 119 adult patients with pathologies of the aortic valve. The mean age of the patients was 38.03 +/- 13.6 years (range 17-78 years). Thirty had had previous cardiac surgery. The principal indication was endocarditis (n = 45). In 66 patients one or more associated pathologies were present including: an abscess of the left ventricular outflow tract (n = 32), an aneurysm of the ascending aorta (n = 22), mitral incompetence (n = 10), and coronary artery disease (n = 3). The indications for surgery were elective in 77 cases and urgent in 45. The CAA was implanted as a total root replacement in 46 patients and as a free-hand in 76. In 66 patients an associated procedure such as a left ventricular outflow tract reconstruction (in 27 cases) was performed. RESULTS: The in-hospital mortality was 5.73% (7/122). In one patient the CAA was replaced before discharge with another CAA because of a mediastinitis with endocarditis by Candida albicans. At the follow-up of the 114 patients discharged from the hospital (mean 50.11 months, range 1-126 months), 6 patients died and 6 were reoperated. The actuarial 10-year survival, reoperation-free, endocarditis-free, structural degeneration-free rates were respectively 83.88, 81.70, 86.30, and 92.80%. CONCLUSIONS: From our experience we conclude that CAA are good substitutes for aortic valve replacement and even in desperate situations exhibit an acceptable long-term performance.