AORTIC-VALVE REPLACEMENT WITH CRYOPRESERVED ALLOGRAFTS - MIDTERM RESULTS

Objective: Analysis of the clinical and echocardiographic mid-term results following aortic valve replacement (AVR) with cryopreserved allografts. Design and setting: A cohort study in a tertiary care center. Patients: Fifty patients underwent allograft AVR during the years 1987 through 1992. There were 44 men and 6 women with a mean age of 47.6 +/- 12.2 years (range 22 to 72 years). Indications for operation included: aortic stenosis (AS) 15 patients, aortic regurgitation (AR) 24, and mixed 11. The etiology was: congenital 22, rheumatic 8, degenerative 5, senile calcific 4, malfunctioning aortic valve prosthesis 5, and active endocarditis 6. Outcome measures: Early mortality and morbidity; mid-term survival, functional class, and valve related complications; and two-dimensional Doppler echocardiography to assess valve structure and function. Results: Two patients (4%) died perioperatively of non-cardiac or valve related causes. Long-term follow-up ranged from 4 to 60 months (median 34 months), with no late mortality, recurrence of endocarditis, or thromboembolic events. Thirty-nine patients were in New York Heart Association (NYHA) Class I (83%) and 7 (15%) in Class II. Of these, echocardiogram showed trace or no AR in 42 (98%) and 2+ AR in 1. One allograft was re-replaced with a mechanical valve due to technical failure. One patient was in NYHA Class III with normal allograft function and 4+ mitral regurgitation. Conclusions: Replacement of the aortic valve by a cryopreserved allograft can be performed safely, and is particularly useful in the setting of active endocarditis and failed prior prosthetic valve. Mid-term clinical results and valve durability at 5 years are excellent.