Six year review of the results of freehand aortic valve replacement using an antibiotic sterilized homograft valve.

The long-term behavior of an antibiotic-treated homograft aortic valve inserted in a freehand fashion was assessed in 121 patients operated upon for aortic valve disease and followed from four to six and one-half years. There were seven hospital deaths (5.7%) and 30 late deaths, only one of which was related to the homograft valve. The six year survival was 69% (77% for single valve and 52% for multiple valve surgery). At six years 9% had important homograft aortic valve incompetence (HAVI) and most of these required reoperation. Important HAVI occurred in only 5% of patients with an aortic root diameter less than 24 mm and in 38% of those with a markedly dilated or distorted proximal aorta (P less than 0.01). The freehand aortic homograft was considered superior to prosthetic devices because of the absence of chronic anticoagulation, thromboembolism, sudden death from valve failure and significant obstruction in a small aortic root. With slightly restricted patient selection the valve failure rate is expected to fall to less than 1% per year.