1. Homograft Replacement of the aortic valve:Ten-year results

2. Introduction
In Aortic valve disease the use of cryopreserved homograft is a valuable advantage to mechanical or biological prosthetic for aortic valve replacement.

3. Homograft replacement of the aortic valve has theoretical and pratical advantage.
Good resistance to infection and low risk to reinfection.
Excellent hemodynamic performance.
No pharmacological anticoagulation

4. Homograft Aortic Valve Replacement
Homograft Aortic Valve Replacement. Division of Thoracic and Cardiovascular Surgery. La Pitie’ Paris.
Patients
82 men women
mean age 38,83±16,70

5. 1993 - 2003 111 Patients Endocarditis ( n 52 )
Rheumatic disease ( n 32 )
Bicuspid valve disease ( n 18 )
Dystrophic disease ( n 9 )
AV regurgitation Endocarditis mean 3,63±0,48
AV regurgitation non Endocarditis mean 2,89±0,78

6. 1993 - 2003 52 Endocarditis 38 men 14 women
mean age 41,32±17,94
31 patients Homo-AVR native valve
21 patients Homo-AVR non native valve.
Mechanical Prostethic Valve

7. Operative Data

8. Operative Data

9. 10 years results.111 Patients
Mean follow up was 61±35 months. 118 months maximum
Overall hospital mortality patients ,57%
Non Endocarditis %
Endocarditis ,57
Late death patients
Homograft failure and reoperation (30 days) 0%

10. 10 years results. Causes of late complications
Reoperation
Early reoperation < 3 months
Late reoperation (1pt two times )
Endocarditis
Ischemic or Emorragic events
Calcifications without reoperation

11. 10 years results. Reoperation

12. Early and Late complications

16. 10 years results. 52 Endocarditis
10 years survival was 97%
Patients free from cardiac death was 100%
10 years freedom for major cardiacs events was
95%
10 years freedom from recurrent endocarditis
was 96%

17. Complex endocarditis involving the aortic root and interventricular septum remains a great challenge in the aortic replacement surgery
Endocarditis is frequently associated with systemic embolization and neurological injury that may be conditioned early survival

18. Valve replacement in the presence of native and prosthetic endocarditis remains a great problem (bet).
Homograft replacement of the aortic valve is the preferred for these patients with complex endocarditis even if concomitant mitral valve disease and regurgitation required valve replacement or repair

19. CONCLUSION
The present result confirmed good long term-result for aortic valve replacement with cryopreserved homograft and risk of valve-related death or recurrent endocarditis is very low at long-term follow up.

23. Operative Data.

24. Operative Data

25. Previous Cardiac Operation (N 42)
20 patients Aortic Root and Septum involving
10 Aortic Root patch
3 Aortic Root and Septum patch
7 Only Root replacement
13 patients Mitral Valve Regurgitation
mean regurgitation 2,07±0,64
13 Mitral Valve Repair
2 patients By pass
2 patients Others

26. 10 years results.111 Patients Reoperations
11 patients early complication.
Low cardiac output patients
Pulmonary infection «  «  « 
Bleeding «  «  «