Long-term outcome of cryopreserved allograft for aortic valve replacement

Nappi, F., Nenna, A., Petitti, T., Spadaccio, C., Gambardella, I., Lusini, M., Chello, M. and Acar, C. (2018) Long-term outcome of cryopreserved allograft for aortic valve replacement. Journal of Thoracic and Cardiovascular Surgery, 156(4), 1357-1365.e6. (doi: 10.1016/j.jtcvs.2018.04.040) (PMID:29759737)

Abstract

Objective: The most efficient surgical approach to severe aortic valve disease in the young adult is still debated: cryopreserved aortic allograft offers excellent hemodynamic and avoid anticoagulation, but long-term durability is influenced by structural valve deterioration (SVD). This study aimed to describe long-term results of aortic allografts and to identify factors influencing long-term durability. Methods: From January 1993 to August 2010, 210 patients underwent aortic allograft replacement via the free-hand subcoronary implantation technique (N = 55) or root replacement with coronary reimplantation (N = 155). Clinic and echocardiographic follow-up was updated to April 2016. Results: Overall mortality and cardiac mortality occurred in 80 (38.1%) and 64 (30.5%) patients, respectively. Reoperation was required in 69 cases (32.8%), whereas SVD required reoperation in 57 cases (27.1%). No early endocarditis occurred, whereas late endocarditis occurred in 4 patients. The free-hand technique seems to be associated with improved left ventricular remodeling compared with the root-replacement technique, and smaller allograft size represents a predictor of reoperation independently on the surgical technique used. In the overall population, there were 44 women of childbearing age, and 37 patients remained pregnant during the follow-up of the study. No differences were found in the clinical outcomes among women who had children and who did not. Conclusions: Cryopreserved allograft is a valid option, especially in complex infective endocarditis and in women of childbearing age. A careful choice of allograft size and implantation technique can reduce the risk of SVD.

• Item Type: Articles
• Keywords: Allograft, aortic valve replacement, cryopreserved aortic allograft, endocarditis, long-term, structural valve degeneration.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Spadaccio, Dr Cristiano
• Authors: Nappi, F., Nenna, A., Petitti, T., Spadaccio, C., Gambardella, I., Lusini, M., Chello, M., and Acar, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Thoracic and Cardiovascular Surgery
• Publisher: Elsevier
• ISSN: 0022-5223
• ISSN (Online): 1097-685X
• Published Online: 18 April 2018