Aortic root replacement with a cryopreserved allograft was associated with significantly less grade ≥2 valve dysfunction at 10 to 15 years compared to the subcoronary technique (0% vs 40%, P<0.001).
Cohort (n=570)
Does the root replacement technique reduce AAV dysfunction compared to subcoronary or inclusion cylinder techniques in patients undergoing aortic valve replacement with cryopreserved aortic allograft?
Absolute Event Rate: 0% vs 40%
p-value: p=<0.001
Background — Despite the many advantages of an aortic allograft valve (AAV) over a prosthetic aortic valve, its durability is suboptimal. The aims of the present study were to document characteristic features of AAV dysfunction and to investigate factors influencing the development of such dysfunction. Methods and Results — A group of 570 patients (mean age, 48±16 years) with a cryopreserved AAV underwent a follow-up echocardiographic study (mean time after surgery, 6.8 years; range, 1.0 to 22.9 years). Significant AAV regurgitation was present in 14.7% of patients, and AAV stenosis was present in 3.2%. The root replacement subgroup had the smallest number of patients with significant AAV regurgitation (5.0%) compared with the subcoronary (23.0%) or the inclusion cylinder technique subgroup (14.7%). After 10 to 15 years after AAV replacement, grade ≥2 AAV dysfunction was present in 40% of patients in the subcoronary subgroup, but no significant dysfunction was observed in patients in the root replacement subgroup ( P <0.001). Smaller host aortic annulus size in both subcoronary (coefficient, −0.145; P =0.013) and root replacement subgroups (coefficient, −0.249; P =0.011) was associated with more frequent AAV dysfunction (grade ≥2). In addition, significant AAV dysfunction was more frequent when patients were younger (coefficient, −0.020; P =0.015) in the subcoronary subgroup and the donor was older (coefficient, 0.054; P =0.019) in the root replacement subgroup. Conclusions — The present study indicates that the root replacement technique is associated with less frequent AAV degeneration. Our findings should help in establishing more strict selection criteria for surgical replacement procedure type and patient/donor factors for AAV replacement and, therefore, could lead to improve AAV longevity.
Palka et al. (2002) conducted a cohort in Aortic valve disease requiring replacement (n=570). Root replacement technique vs. Subcoronary technique was evaluated on Grade ≥2 aortic allograft valve dysfunction at 10 to 15 years (p=<0.001). Aortic root replacement with a cryopreserved allograft was associated with significantly less grade ≥2 valve dysfunction at 10 to 15 years compared to the subcoronary technique (0% vs 40%, P<0.001).