PMID- 37367413
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230701
IS  - 2308-3425 (Electronic)
IS  - 2308-3425 (Linking)
VI  - 10
IP  - 6
DP  - 2023 Jun 8
TI  - The Use of the Cryopreserved Aortic Homograft for Aortic Valve Replacement: Is It 
      Still an Option?
LID - 10.3390/jcdd10060248 [doi]
LID - 248
AB  - The indications for cryopreserved allografts in aortic valve replacement are 
      still debatable. We aim to identify factors influencing early and long-term 
      durability of the aortic homograft and to define subgroups of patients with an 
      improved long-term quality of life, survival, and freedom from structural valve 
      degeneration (SVD). We evaluated our series of 210 patients who underwent 
      allograft implantation with a retrospective cohort study design over a period of 
      20 years. Endpoints were overall mortality, cardiac mortality related to SVD, the 
      incidence of SVD, reoperation, and a composite endpoint comprising major adverse 
      cardiac and cerebrovascular events (MACCEs), which includes cardiac death both 
      related and not related to SVD, subsequent aortic valve surgery, new or recurrent 
      infection of implanted allograft, recurrent aortic regurgitation, 
      rehospitalization for heart failure, an increase in New York Heart Association 
      (NYHA) class of >/=1, or cerebrovascular events. The primary indication for surgery 
      was endocarditis (48%), which was also a predisposing factor for increased 
      cardiac mortality. Overall mortality was 32.4% with a 27% incidence of SVD and 
      mortality associated with SVD of 13.8%. Reoperation occurred in 33.8% and MACCEs 
      in 54.8%. Long-term NYHA functional class and echocardiographic parameters 
      improved over time. Statistical analysis demonstrated that root replacement 
      technique and adult age were protective factors for SVD. We found no 
      statistically significant difference in the clinical outcomes analyzed between 
      women of childbearing age who had children after surgery and the rest of the 
      women. The cryopreserved allograft is still a valid option in aortic valve 
      replacement, providing acceptable durability and clinical outcomes with optimal 
      hemodynamic performance. SVD is influenced by the implantation technique. Women 
      of childbearing age might have additional benefits from this procedure.
FAU - Nappi, Francesco
AU  - Nappi F
AUID- ORCID: 0000-0002-9705-5360
AD  - Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint Denis, 
      France.
FAU - Nenna, Antonio
AU  - Nenna A
AUID- ORCID: 0000-0002-4069-6781
AD  - Department of Cardiovascular Surgery, Universita Campus Bio-Medico di Roma, Via 
      Alvaro del Portillo, 00128 Roma, Italy.
FAU - Spadaccio, Cristiano
AU  - Spadaccio C
AD  - Cardiothoracic Surgery, Lancashire Cardiac Center, Blackpool Victoria Hospital, 
      Blackpool FY3 8NP, UK.
FAU - Avtaar Singh, Sanjeet Singh
AU  - Avtaar Singh SS
AUID- ORCID: 0000-0003-4320-0734
AD  - Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh 
      EH16 4SA, UK.
FAU - Almazil, Almothana
AU  - Almazil A
AD  - Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint Denis, 
      France.
FAU - Acar, Christophe
AU  - Acar C
AD  - Department of Cardiothoracic Surgery, Hopital Pitie-Salpetriere, Boulevard de 
      Hopital 47-83, 75013 Paris, France.
LA  - eng
PT  - Journal Article
DEP - 20230608
PL  - Switzerland
TA  - J Cardiovasc Dev Dis
JT  - Journal of cardiovascular development and disease
JID - 101651414
PMC - PMC10299650
OTO - NOTNLM
OT  - aortic homograft
OT  - aortic valve disease
OT  - aortic valve replacement
OT  - endocarditis
OT  - pregnancy
COIS- The authors declare no conflict of interest.
EDAT- 2023/06/27 13:10
MHDA- 2023/06/27 13:11
PMCR- 2023/06/08
CRDT- 2023/06/27 10:05
PHST- 2023/04/01 00:00 [received]
PHST- 2023/05/28 00:00 [revised]
PHST- 2023/06/06 00:00 [accepted]
PHST- 2023/06/27 13:11 [medline]
PHST- 2023/06/27 13:10 [pubmed]
PHST- 2023/06/27 10:05 [entrez]
PHST- 2023/06/08 00:00 [pmc-release]
AID - jcdd10060248 [pii]
AID - jcdd-10-00248 [pii]
AID - 10.3390/jcdd10060248 [doi]
PST - epublish
SO  - J Cardiovasc Dev Dis. 2023 Jun 8;10(6):248. doi: 10.3390/jcdd10060248.