TY - JOUR
T1 - Subcoronary Allograft Aortic Valve Replacement
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.
PY - 2007/11
Y1 - 2007/11
N2 - 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.
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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U2 - 10.1016/j.athoracsur.2007.02.100
DO - 10.1016/j.athoracsur.2007.02.100
M3 - Article
C2 - 17954063
AN - SCOPUS:35348860711
SN - 0003-4975
VL - 84
SP - 1564
EP - 1570
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -