Subcoronary Allograft Aortic Valve Replacement: Parametric Risk-Hazard Outcome Analysis to a Minimum of 20 Years

Edward Hickey, Stephen M. Langley, Oliver Allemby-Smith, Steven A. Livesey, James L. Monro

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Differences in sterilization, preservation, and implantation have been implicated in aortic allograft longevity. We report follow-up to 30 years of patients from a single unit who underwent aortic valve replacement with aortic allografts sterilized in antibiotics and refrigerated at 4°C. Methods: Two hundred consecutive patients underwent subcoronary allograft aortic valve replacement and have been followed up to a minimum of 20 and maximum of 30 years. Follow-up was 96% complete. Parametric hazard phase modeling was used to identify incremental predictors of time-related risk. Results: Early mortality was 1.5%. Kaplan-Meier actuarial survival, including early death, was 81.2% ± 2.8% (mean ± standard error of the mean), 58.0% ± 3.7%, and 52% ± 5.1% at 10, 20, and 25 years, respectively. Freedom from reoperation for any reason was 86.4% ± 2.6%, 39.6% ± 5.2%, and 35.0% ± 5.4% at 10, 20, and 25 years, respectively. Larger implanted valve, reexploration for bleeding, previous cardiac surgery, and operative rank were independent risks for reoperation. Early mortality in reoperations was 5.1%. Allograft endocarditis has occurred in 6 patients, giving an overall freedom of 94% at 25 years. Seven patients of the original cohort are known to be alive with their original allograft valve in situ, and of these the longest follow-up period is 29.8 years. Conclusions: The use of antibiotic-sterilized allografts for subcoronary aortic valve replacement confers low operative mortality and excellent long-term survival with durability matching any other nonmechanical device. Significantly reduced time-related risk of reoperation and excellent internal to external diameter ratio renders allograft aortic valve replacement especially ideal for smaller roots.

Original languageEnglish (US)
Pages (from-to)1564-1570
Number of pages7
JournalAnnals of Thoracic Surgery
Volume84
Issue number5
DOIs
StatePublished - Nov 2007
Externally publishedYes

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Aortic Valve
Allografts
Reoperation
Mortality
Anti-Bacterial Agents
Survival
Endocarditis
Thoracic Surgery
Hemorrhage
Equipment and Supplies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Subcoronary Allograft Aortic Valve Replacement : Parametric Risk-Hazard Outcome Analysis to a Minimum of 20 Years. / Hickey, Edward; Langley, Stephen M.; Allemby-Smith, Oliver; Livesey, Steven A.; Monro, James L.

In: Annals of Thoracic Surgery, Vol. 84, No. 5, 11.2007, p. 1564-1570.

Research output: Contribution to journalArticle

Hickey, Edward ; Langley, Stephen M. ; Allemby-Smith, Oliver ; Livesey, Steven A. ; Monro, James L. / Subcoronary Allograft Aortic Valve Replacement : Parametric Risk-Hazard Outcome Analysis to a Minimum of 20 Years. In: Annals of Thoracic Surgery. 2007 ; Vol. 84, No. 5. pp. 1564-1570.
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abstract = "Background: Differences in sterilization, preservation, and implantation have been implicated in aortic allograft longevity. We report follow-up to 30 years of patients from a single unit who underwent aortic valve replacement with aortic allografts sterilized in antibiotics and refrigerated at 4°C. Methods: Two hundred consecutive patients underwent subcoronary allograft aortic valve replacement and have been followed up to a minimum of 20 and maximum of 30 years. Follow-up was 96{\%} complete. Parametric hazard phase modeling was used to identify incremental predictors of time-related risk. Results: Early mortality was 1.5{\%}. Kaplan-Meier actuarial survival, including early death, was 81.2{\%} ± 2.8{\%} (mean ± standard error of the mean), 58.0{\%} ± 3.7{\%}, and 52{\%} ± 5.1{\%} at 10, 20, and 25 years, respectively. Freedom from reoperation for any reason was 86.4{\%} ± 2.6{\%}, 39.6{\%} ± 5.2{\%}, and 35.0{\%} ± 5.4{\%} at 10, 20, and 25 years, respectively. Larger implanted valve, reexploration for bleeding, previous cardiac surgery, and operative rank were independent risks for reoperation. Early mortality in reoperations was 5.1{\%}. Allograft endocarditis has occurred in 6 patients, giving an overall freedom of 94{\%} at 25 years. Seven patients of the original cohort are known to be alive with their original allograft valve in situ, and of these the longest follow-up period is 29.8 years. Conclusions: The use of antibiotic-sterilized allografts for subcoronary aortic valve replacement confers low operative mortality and excellent long-term survival with durability matching any other nonmechanical device. Significantly reduced time-related risk of reoperation and excellent internal to external diameter ratio renders allograft aortic valve replacement especially ideal for smaller roots.",
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T2 - Parametric Risk-Hazard Outcome Analysis to a Minimum of 20 Years

AU - Hickey, Edward

AU - Langley, Stephen M.

AU - Allemby-Smith, Oliver

AU - Livesey, Steven A.

AU - Monro, James L.

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AB - Background: Differences in sterilization, preservation, and implantation have been implicated in aortic allograft longevity. We report follow-up to 30 years of patients from a single unit who underwent aortic valve replacement with aortic allografts sterilized in antibiotics and refrigerated at 4°C. Methods: Two hundred consecutive patients underwent subcoronary allograft aortic valve replacement and have been followed up to a minimum of 20 and maximum of 30 years. Follow-up was 96% complete. Parametric hazard phase modeling was used to identify incremental predictors of time-related risk. Results: Early mortality was 1.5%. Kaplan-Meier actuarial survival, including early death, was 81.2% ± 2.8% (mean ± standard error of the mean), 58.0% ± 3.7%, and 52% ± 5.1% at 10, 20, and 25 years, respectively. Freedom from reoperation for any reason was 86.4% ± 2.6%, 39.6% ± 5.2%, and 35.0% ± 5.4% at 10, 20, and 25 years, respectively. Larger implanted valve, reexploration for bleeding, previous cardiac surgery, and operative rank were independent risks for reoperation. Early mortality in reoperations was 5.1%. Allograft endocarditis has occurred in 6 patients, giving an overall freedom of 94% at 25 years. Seven patients of the original cohort are known to be alive with their original allograft valve in situ, and of these the longest follow-up period is 29.8 years. Conclusions: The use of antibiotic-sterilized allografts for subcoronary aortic valve replacement confers low operative mortality and excellent long-term survival with durability matching any other nonmechanical device. Significantly reduced time-related risk of reoperation and excellent internal to external diameter ratio renders allograft aortic valve replacement especially ideal for smaller roots.

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