Early Clinical Experience with Homotransplantation of the Aortic Valve

Twenty-five patients with predominant aortic valvular disease have had replacement with a homograft aortic valve inserted after the fashion of Barratt-Boyes. Recently used valves have been stored at -80 C, allowing prolonged storage and rapid reconstitution. There were five early deaths (20%), none of which was directly attributable to the choice of valve. Of three late deaths (12%) in up to 18 months follow-up, two were found to be due to complications of the valve resulting in aortic regurgitation-one secondary to a peripheral leak, the other to a fungal endocarditis. All 17 survivors are greatly improved. All 11 patients who have survived over four months have returned to their former occupations. Five (29%) have no murmurs and 12 (71%) have no diastolic murmur. The five that have diastolic murmurs all show evidence of improvement. Tailoring the recipient annulus to fit the donor valve by means of "V" excision of the noncoronary sinus has been very important in minimizing the problem of valvular insufficiency. Recatheterization at one year has revealed no systolic gradient in four patients. Aortic regurgitation was minimal in one patient. There has been no thromboembolism, although anticoagulants are not used. These promising early results support continued use and evaluation of the homograft aortic valve.