Twenty-year follow-up of aortic valve replacement with antibiotic sterilized homografts in 200 patients.

The aim of this study was to determine long-term results from one unit of subcoronary homograft aortic valve replacement (AVR) using the same sterilization and preservation techniques in each case. Between 1973 and 1983, 200 patients underwent AVR using an unstented homograft previously sterilized in antibiotics and preserved at 4 degrees C. Surviving patients were monitored for a minimum of 15 years to the end of 1998. Mean age was 50.0+/-14 (1 standard deviation) years; 121 patients were men (60.5%). Mean patient follow-up time was 15.6+/-6.7 years, with a total follow-up time of 3,115 patient years. Follow-up was 95.6% complete. There were three early deaths (1.5%). At autopsy, the homograft was anatomically normal and in a satisfactory position. Kaplan-Meier survival, including early death, was 81.2%+/-2.8% (1 standard error) at 10 years, 68.1%+/-3.4% at 15 years, and 58.0%+/-3.7% at 20 years. Repeat AVR was undertaken in 74 patients, giving a freedom from reoperation for any reason of 86.5%+/-2.6%, 69.6%+/-3.8%, and 38.8%+/-5.3% at 10, 15, and 20 years, respectively. Freedom from structural valve degeneration at 10, 15, and 20 years was 81.1%+/-2.9%, 61.7%+/-3.9%, and 31.2%+/-4.7%, respectively. Freedom from endocarditis at 10, 15, and 20 years was 98.7%+/-0.9%, 96.0%+/-1.8%, and 94.6%,+/-2.3%, respectively. Homograft AVR with an antibiotic-sterilized valve stored at 4 degrees C and implanted in the subcoronary position offers low operative mortality and good long-term outcome for patients.