Aortic Valve HomograftsA Cinical Perspective.ppt

3/98 Aortic Valve HomograftsA Cinical Perspective Michael E. Staab, MD Rick A. Nishimura, MD Joseph A. Dearani, MD Thomas A. Orszulak, MD Mayo Clin Proc 1998; 73:231-238 Valve Prosthesis Mechanical types: caged-ball, tilting-disk, bi-leaflet advantage: durability limitation: thrombogenicity Bioprosthetic types: heterografts, homografts advantage: short term anticoagulation limitation: structural failure Mechanical Valve Prosthesis Types caged-ball (Starr-Edwards) tilting-disk (Medtronic-Hall) bileaflet (St Jude) Advantage: durability (1) Limitation: thrombogenicity Bioprosthetic Heterografts advantage long term anticoagulation unnecessary (1) limitation: structural failure leaflet calcification tissue degeneration leading to valvular regurgitation stenosis is uncommon rate of porcine valve degeneration 26% (aortic), 39% (mitral) in 10 yrs (2) Bioprosthetic Homografts 1956 - first aortic valve homograft was used in the descending thoracic aorta for aortic regurgitation 1962 - first sub-coronary use high incidence of post-op failure * (years) 5 10 15 20 survival rate (%) 85 66 53 38 re-operation (%) 22 62 85 95 Bioprosthetic Homografts early preservation techniques formaldehyde, chlorhexidine, propiolactone, ethylene oxide, ?-irridiation, freezing at -70oC grafts are nonviable high incidence of cusp rupture Bioprosthetic Homograftsadvances Improving valve durability newer preservation techniques: cryopreservation by liquid nitrogen with low-dose antibiotics homovital grafts (fresh unpreserved) reduced time for graft procurement donor rather than autopsy specimens Bioprosthetic HomograftsUniversity of Alabama 1981-1991 cryopreserved aortic grafts in 178 pts survival rate 91% at 1 year 85% at 8 years freedom from re-operation 95% at 8 years Bioprosthetic HomograftsPrince Charles Hsopital 1975-1994 cryopreserved aortic grafts in 680 pts hospital mortality 2.8% survival rate 77% at 10 year; 45% at 20 years freedom from re-operation 69% at 15 years Hom