Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

Objective: The aim of this study was to analyze the midterm clinical results of aortic valve replacement with cryopreserved homografts. Materials and Methods: Aortic valve replacement was performed in 40 patients with cryopreserved homograft. The indications were aortic valve endocarditis in 20 patients (50%), truncus arteriosus in 6 patients (15%), and re-stenosis or regurtitation after aortic valve reconstruction in 14 (35%) patients. The valve sizes ranged from 10 to 27mm. A full root replacement technique was used for homograft replacement in all patients. Results: The 30-day postoperative mortality rate was 12.5% (5 patients). There were four late deaths. Only one of them was related to cardiac events. Overall mortality was 22.5%. Thirty-three patients were followed up for 67aplusmn;26 months. Two patients needed reoperation due to aortic aneurysm caused by endocarditis. The mean transvalvular gradient significantly decreased after valve replacement (palt;0.003). The last follow up showed that the 27 (82%) patients had a normal left ventricular function. Conclusion: Cryopreserved homografts are safe alternatives to mechanical valves that can be used when there are proper indications. Although it has a high perioperative mortality rate, cryopreserved homograft implantation is an alternative for valve replacement, particularly in younger patients and for complex surgical problems such as endocarditis that must be minimalized. Turkish Baslik: Kriyopreserve Homogreft Ile Aort Kapak Replasmani Orta Donem Sonuclari Anahtar Kelimeler: Aort kapak replasmani, kriyopreserve homogreft, endokardit, kalp kapak bankasi Amac: Calismada kriyoprezerve homogreftler ile kapak replasman sonuclarinin orta donem sonuclari incelenmistir. Hastalar ve Yontemler: Kriyopreserve homogreft ile 40 olguda aort kapak replasmani yapildi. Endikasyonlar; 20 olguda aort kapak endokarditi, 6 olguda truncus arteriosus ve 14 olguda aort kapak tamir proseduru sonrasi reoperasyonlardi. Kapak caplari 10-27mm idi. Tum olgularda kok replasman teknigi kullanildi. Bulgular: Operasyon sonrasi 30 gunluk mortalite orani %12,5a#39;ti. Gec donemde 4 olgu kaybedildi. Sadece 1 olguda mortalite kardiyak nedenlere bagliydi. Toplam mortalite orani %22,5a#39;ti. 33 olgu ortalama 67aplusmn;26 aylik surecte izlendi. Endokardite bagli aort anevrizmasi nedeni ile 2 olgu tekrar ameliyat edildi. Replasman sonrasi transvalvular gradiyentlerde istatistiksel anlamli dusus gozlendi (palt;0.03). Son takip sonuclari 27 olgunun normal sol ventrikul fonksiyonuna sahip oldugunu gostermistir. Sonuc: Kriyopreserve homogreftler mekanik kapaklara bir alternatif olusturmaktadirlar ve uygun endikasyonlarda guvenle kullanilabilirler. Calismamizdaki yuksek erken mortaliteye ragmen; ozellikle buyume cagindakiler ve endokardit gibi ortadan kaldirilmasi gerekli ozel cerrahi sorunlarin giderilmesinde kriyopreserve homogreftler guvenli bir alternatif olusturmaktadir.