Fergus
Like everyone I know the basic pros and cons or mechanical V homograft
Even though you said you knew this, I thought I'd go and dig out the followup study done by my surgeons who did my homograft back in 1992. The information may be of use to you. I don't normally see such long term follow up (
or one that comprehensively follows such a large cohort)
I was 28 when I had my valve done by them (in 1992) and seems I was about one of their best jobs having
freedom from reoperation for 20 years.
The homograft aortic valve: a 29-year, 99.3% follow up of 1,022 valve replacements.
O'Brien MF, Harrocks S, Stafford EG, Gardner MA, Pohlner PG, Tesar PJ, Stephens F.
The Prince Charles Hospital and the St Andrew's Hospital, Brisbane, Queensland, Australia.
BACKGROUND AND AIM OF THE STUDY:
The study aim was to elucidate the advantages and limitations of the homograft aortic valve
for aortic valve replacement over a 29-year period.
METHODS:
Between December 1969 and December 1998, 1,022 patients
(males 65%; median age 49 years; range: 1-80 years) received either
a subcoronary (n = 635),
an intraluminal cylinder (n = 35),
or a full root replacement (n = 352).
There was a unique result of a 99.3% complete follow up at the end of this 29-year experience.
Between 1969 and 1975, homografts were antibiotic-sterilized and 4 degrees C stored (124 grafts);
thereafter, all homografts were cryopreserved under a rigid protocol with only minor
variations over the subsequent 23 years.
Concomitant surgery (25%) was primarily coronary artery bypass grafting (CABG; n = 110)
and mitral valve surgery (n = 55).
The most common risk factor was acute (active) endocarditis (n = 92; 9%),
and patients were in NYHA class II (n = 515), III (n = 256), IV (n = 112) or V (n = 7).
RESULTS:
The 30-day/hospital mortality was 3% overall, falling to 1.13 +/- 1.0%
for the 352 homograft root replacements.
Actuarial late survival at 25 years of the total cohort was 19 +/- 7%.
Early endocarditis occurred in two of the 1,022 patient cohort,
and freedom from late infection (34 patients) actuarially at 20 years was 89%.
One-third of these patients were medically cured of their endocarditis.
Preservation methods (4 degrees C or cryopreservation) and implantation techniques
displayed no difference in the overall actuarial 20-year incidence
of late survival endocarditis, thromboembolism or structural degeneration requiring operation.
Thromboembolism occurred in 55 patients (35 permanent, 20 transient)
with an actuarial 15-year freedom in the 861 patients having aortic valve replacement
+/- CABG surgery of 92% and in the 105 patients having additional
mitral valve surgery of 75% (p = 0.000).
Freedom from reoperation from all causes was 50% at 20 years
and was independent of valve preservation.
Freedom from reoperation for structural deterioration was very patient age-dependent.
For all cryopreserved valves, at 15 years, the freedom was
47% (0-20-year-old patients at operation),
85% (21-40 years),
81% (41-60 years) and
94% (>60 years).
Root replacement versus subcoronary implantation reduced the technical causes for
reoperation and re-replacement (p = 0.0098).
CONCLUSION: This largest, longest and most complete follow up demonstrates
the excellent advantages of the homograft aortic valve for the treatment of acute
endocarditis and for use in the 20+ year-old patient.
However, young patients (< or = 20 years) experienced only a 47% freedom from reoperation
from structural degeneration at 10 years such that alternative valve devices are indicated
in this age group. The overall position of the homograft in relationship to other
devices is presented.
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now ... with a mechanical valve freedom from reoperation is potentially much longer. Dick (
a member here) has so far had something like 46 years freedom from reoperation. So while there is no guarantee that your mechanical will last that long,
there is no tissue valve that ever gets that.
