Aortic homograft valve replacement provides symptomatic improvement but is associated with significant late failure (incompetence and calcification) linked to chemical sterilization and freeze-drying preparation methods.
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Late failures caution against routine homograft use; leaves open optimal preservation methods for future valve research.
An initial series of 101 patients with a homograft aortic valve has been reviewed from 4 to 6 years postoperatively. There were six hospital and 24 late deaths, eight of which were due to homograft valve failure. The 71 surviving patients were all symptomatically improved. Anticoagulants were not used, and emboli were thought not to originate from the valve. Important incompetence occurred in 27 patients and reoperation was undertaken in 17 of these. The causes were peripheral leaking of the suture line, cusp rupture, bacterial endocarditis, and valve misplacement. Leaflet calcification produced stenosis, requiring reoperation in two patients, and was significant in eight other valves. Precipitating causes, present in eight of the 10 cases, were imperfections in the original homograft, valve misplacement, or endocarditis. Both cusp rupture and leaflet calcification were related to the method of valve preparation as neither was encountered in untreated valves. For this reason, chemical sterilization and freeze drying have been replaced by sterilization and storage in an antibiotic Hank's solution.
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Barratt‐Boyes et al. (1969) studied this question.
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