What question did this study set out to answer?

To evaluate the long-term clinical outcomes, durability, and risk factors for valve failure in patients receiving antibiotic-sterilized freehand aortic homograft valves.

April 1, 1987Circulation

Long-term follow-up of patients with the antibiotic-sterilized aortic homograft valve inserted freehand in the aortic position.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic valve disease requiring replacement (n=248). Intervention: Antibiotic-sterilized aortic homograft valve. Primary outcome: Actuarial survival with the study valve in situ at 10 years.

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Key result

Antibiotic-sterilized aortic homograft valves demonstrated an actuarial survival with the valve in situ of 57% at 10 years and 38% at 14 years.

Why the study?

Does the antibiotic-sterilized aortic homograft valve provide long-term survival and freedom from incompetence in patients requiring aortic valve replacement?

Key Points

To evaluate the long-term clinical outcomes, durability, and risk factors for valve failure in patients receiving antibiotic-sterilized freehand aortic homograft valves.
Followed 248 patients receiving 252 antibiotic-sterilized, nutrient-stored nonvital aortic homograft valves for 9 to 16.5 years (mean 10.8 years).
Performed actuarial survival analysis and multivariate risk factor analysis for late valve incompetence and failure.
Actuarial survival with the original valve in situ was 57% at 10 years and 38% at 14 years, with an in-hospital mortality of 6.0% overall and 2.7% for elective first operations.
Freedom from significant valve incompetence for the whole cohort was 95% at 5 years, 78% at 10 years, and 42% at 14 years.
Multivariate analysis identified donor valve age ≥55 years, recipient age <15 years, and aortic root diameter >30 mm as significant risk factors for wear-related incompetence; low-risk patients without these factors achieved 94% freedom from wear-related failure at 9 years and 56% at 13 years.

Study Design

Type

Cohort (n=248)

Structured PICO

Does the antibiotic-sterilized aortic homograft valve provide long-term survival and freedom from incompetence in patients requiring aortic valve replacement?

Population

248 patients receiving 252 isolated aortic homograft valves

Intervention

Antibiotic-sterilized aortic homograft valve inserted freehand in the aortic position

Outcome

Actuarial survival with the study valve in situ and freedom from significant incompetencehard clinical

Antibiotic-sterilized aortic homograft valves demonstrate reasonable 10-year survival and freedom from incompetence, but durability declines significantly by 14 years, especially with older donor valves, young recipients, or large aortic roots.

Discussion

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Implication

May support homograft use up to 10 years in aortic replacement; leaves open durability beyond 14 years and optimal patient selection.

Cite This Study

Barratt‐Boyes et al. (1987) conducted a cohort in Aortic valve disease requiring replacement (n=248). Antibiotic-sterilized aortic homograft valve was evaluated on Actuarial survival with the study valve in situ at 10 years. Antibiotic-sterilized aortic homograft valves demonstrated an actuarial survival with the valve in situ of 57% at 10 years and 38% at 14 years.

synapsesocial.com/papers/6a0ccbd5291fe4aa62625585 https://doi.org/10.1161/01.cir.75.4.768

Topics

Infective endocarditis

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Long-term follow-up of patients with the antibiotic-sterilized aortic homograft valve inserted freehand in the aortic position.

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Topics

Long-term follow-up of patients with the antibiotic-sterilized aortic homograft valve inserted freehand in the aortic position.

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider