TWENTY-EIGHT YEARS FOLLOW-UP OF PRIMARY AORTIC VALVE REPLACEMENT
WITH ALLOGRAFTS -AN ECHOCARDIOGRAPHIC STUDY OF 613 PATIENTS. P. Palka*, S. Harrocks, A. Lange, M.
Davison, D. Burstow, M. O'Brien. Departments of Echocardiography and Cardiac
Surgery, The Prince Charles Hospital, Brisbane, Qld. Since the 1960s when aortic allografts (AA) have been introduced,
it has been apparent that this kind of aortic valve surgery offers
many advantages over the prosthetic valves. The main concern
regarding the AA is its durability. Aim of this study was
to assess the contributing factors for long time uneventful longevity
of AA and to define potential failure factors in this group of patients
during the 28-year follow-up. AA implantation was performed
by a subcoronary technique or a total root replacement in a group
of 1022 pts (mean age 48±17 years, 669 male). The AA
were cryopreserved (n=898) or nonviable (n=124). Results: 30-day mortality for the entire group was 3.0% (the
last consecutive 352 pts all having root replacement was 1.1%).
Crude survival was 65% at >25 years follow-up. The re-operation
rate was 11.2% (n=135) at a mean time post surgery of 9.4 ±
5.8 years. To assess the performance of AA, echocardiographic
studies were performed between 1996-1998 in 613 patients (between
89 days to 25 years post AA implantation, mean 6.7 years).
During that period, in 487 (79%) patients there were no echocardiographic
signs of either AA stenosis (AAS) or regurgitation (AAR).
42 patients (7%) had AAS and 81 (13%) AAR. There was no differences
between AAS, AAR and normal AA in several valve-and procedure-related
determinants (see Table). However, AA patients who died or
had aortic valve re-operation had larger aortic annulus size (recipients
to donor difference) as compared to patients with normal AA derived
by echocardiogram (3.4±2.2cm vs 2.3±2.2cm, P<0.001). AAS AAR Normal
AA (n=490) Non‑-
viable Aortic Valve 0 3
(4%) 6
(1%) Cryopreserved
Aortic Valve 42
(100%) 78
(96%) 484
(99%) Procurement
time (hrs) 14.3±8.1 14.8±7.5 15.2±8.5 Patients
age (yrs) 41±19 50±16 47±16 Age
recipient/donor Difference (yrs) 14±23 20±23 15±21 Aortic
annulus Recipients/donor difference (cm) 2.3±1.6 2.7±2.5 2.3±2.3 Conclusions: AA replacement gives good long term results
at follow-up of up to 28 years. There was a trend for AAR
patients and those who died or needed re-operation to be older and
have bigger annulus diameter. No other specific patient
(n=42)
(n=81)
