Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

Yıl 2012, , 170 - 173, 01.02.2012

Can Vuran Paul Simon Gregor Wollenek Emre Özker Erdal Aslım

https://doi.org/10.5152/balkanmedj.2011.017

Öz

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 67±26 months. Two patients needed reoperation due to aortic aneurysm caused by endocarditis. The mean transvalvular gradient significantly decreased after valve replacement (p<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 Başlık: Kriyopreserve Homogreft İle Aort Kapak Replasmanı Orta Dönem Sonuçları Anahtar Kelimeler: Aort kapak replasmanı, kriyopreserve homogreft, endokardit, kalp kapak bankası Amaç: Çalışmada kriyoprezerve homogreftler ile kapak replasman sonuçlarının orta dönem sonuçları incelenmiştir. Hastalar ve Yöntemler: Kriyopreserve homogreft ile 40 olguda aort kapak replasmanı yapıldı. Endikasyonlar; 20 olguda aort kapak endokarditi, 6 olguda truncus arteriosus ve 14 olguda aort kapak tamir prosedürü sonrası reoperasyonlardı. Kapak çapları 10-27mm idi. Tüm olgularda kök replasman tekniği kullanıldı. Bulgular: Operasyon sonrası 30 günlük mortalite oranı %12,5'ti. Geç dönemde 4 olgu kaybedildi. Sadece 1 olguda mortalite kardiyak nedenlere bağlıydı. Toplam mortalite oranı %22,5'ti. 33 olgu ortalama 67±26 aylık süreçte izlendi. Endokardite bağlı aort anevrizması nedeni ile 2 olgu tekrar ameliyat edildi. Replasman sonrası transvalvular gradiyentlerde istatistiksel anlamlı düşüş gözlendi (p<0.03). Son takip sonuçları 27 olgunun normal sol ventrikül fonksiyonuna sahip olduğunu göstermiştir. Sonuç: Kriyopreserve homogreftler mekanik kapaklara bir alternatif oluşturmaktadırlar ve uygun endikasyonlarda güvenle kullanılabilirler. Çalışmamızdaki yüksek erken mortaliteye rağmen; özellikle büyüme çağındakiler ve endokardit gibi ortadan kaldırılması gerekli özel cerrahi sorunların giderilmesinde kriyopreserve homogreftler güvenli bir alternatif oluşturmaktadır.

Anahtar Kelimeler

Aortic valve replacement, cryopreserved homograft, endocarditis, heart valve banking

Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

Öz

Kaynakça

• Bonow RO, Carabello B, De Leon AC. Guidelines for the man- agement of patients with valvular heart disease. J Am Coll Car- diol 1998;32:1486-588. [CrossRef]
• Westaby S, Amarasena N, Long V. Time-related hemodynamic changes after aortic replacement with the Freestyle stentless xenogaft. Ann Thorac Surg 1995;60:1633-9. [CrossRef]
• Hopkins RA. Cardiac Reconstructions with allograft valves. Springer-Werlag New York Inc 1989. [CrossRef]
• Dale J, Leveng O, Enge I. Long term results after aortic valve replacement with four different prostheses. Am Heart J 1980;99:155-62. [CrossRef]
• Horstkotte D, Korfer R, Seipel L. Late complications in patients with Bjork-Shiley and St. Jude medical heart valve replacement. Circulation 1983;68:175-84.
• Haykock D, Barrat-Boyes B, Macedo T. Aortic valve replacement for active infectious endocarditis in 108 patients. A comparison of freehand allograft valves with mechanical prostheses and bio- prostheses. J Thor Cardiovasc Surg 1992;103:130-9.
• Tuna IC, Orszulak TA, Schaff HV. Results of homograft aortic valve replacement for active endocarditis. Ann Thorac Surg 1990;49:619-24. [CrossRef] Balkan Med J 2012; 29: 170-3