Zafar Tufail, Aamar Mansoor, Irfan Azmatullah, Mumraiz S Naqshband, Ahmad Shahbaz, Junaid F Khan, Abdul Waheed.
Midterm results of aortic valve replacement using homograft.
Pak Postgrad Med J Jan ;18(2):56-9.

Objectives: Homograft aortic valves offer many theoretic and proven advantages that include superior hemodynamics, lack of thromboembolism and resistance to infection. However these valves are more difficult to procure. sterilize and insert and have limited durability. The purpose of our study was to analyze our experience with aortic homografts and attempt to define determinants of patient survival and valve function. Methods: Study was conducted at the Cardiac Surgery Department, Punjab Institute of Cardiology, Lahore. Twenty seven patients underwent aortic valve / root replacement using homograft between august 2000 to .luly 2002. Children and adults with aortic stenosis, aortic regurgitation and mixed aortic valve disease were included. Results: There were twenty three male and four female patients. Mean age was 28.6 ± 15.4 years. Homograft ;size used varied between 19 and 29 with the mean of 21 ± 7.8. Thirteen patients had aortic incompetence, ten had aortic stenosis and three suffered from mixed aortic valve disease. In twenty four patients aortic valve was replaced as free hand homograft while three patients underwent aortic root replacement. Aortic homograft was used in fourteen patients while twelve patients had pulmonary homograft. Average cross clamp time was 78 ± 19 minutes and mean by pass time was 134 ± 79 minutes. Mean ICU and hospital stay was 4.4 ± 1.6 days and 11.2 ± days respectively. In hospital mortality was observed in two patients. All patients had transthoracic echocardiogram at six months intervals as part of routine follow up. Fifteen patients had no aortic regurgitation, while nine patients had mild aortic regurgitation. One patient had moderate aortic regurgitation and two had severe aortic regurgitation. All three patients who developed significant aortic regurgitation had pulmonary homograft inserted. None of the patients who had aortic root replacement had significant AR. Conclusions: Mid-term results of aortic valve replacement with homografts are comparable to those of prosthetic valve replacement. In our experience pulmonary homografts have higher failure rate when compared with aortic homografts.

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