Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft

Fukushima, Satsuki, Tesar, Peter J., Pearse, Bronwyn, Jalali, Homayoun, Sparks, Lisa, Fraser, John F. and Pohlner, Peter G. (2014) Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft. Journal of Thoracic and Cardiovascular Surgery, 148 1: 65-72.e2. doi:10.1016/j.jtcvs.2013.07.038


Author Fukushima, Satsuki
Tesar, Peter J.
Pearse, Bronwyn
Jalali, Homayoun
Sparks, Lisa
Fraser, John F.
Pohlner, Peter G.
Title Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft
Journal name Journal of Thoracic and Cardiovascular Surgery   Check publisher's open access policy
ISSN 1097-685X
0022-5223
Publication date 2014-07-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.jtcvs.2013.07.038
Open Access Status Not yet assessed
Volume 148
Issue 1
Start page 65
End page 72.e2
Total pages 10
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Abstract Background: Although the frequency of biological valve use in treating aortic valve disease is increasing, the critical limiting factor, "structural deterioration,'' remains unresolved. Analysis of long-term outcomes after implantation of cryopreserved aortic allografts will yield further information related to the durability of the aortic allograft, possibly suggesting mechanisms underlying or strategies to prevent or treat the structural deterioration of biological valve substitutes.
Formatted abstract
Background

Although the frequency of biological valve use in treating aortic valve disease is increasing, the critical limiting factor, “structural deterioration,” remains unresolved. Analysis of long-term outcomes after implantation of cryopreserved aortic allografts will yield further information related to the durability of the aortic allograft, possibly suggesting mechanisms underlying or strategies to prevent or treat the structural deterioration of biological valve substitutes.

Methods

A total of 840 cryopreserved aortic allografts implanted in the last 35 years were reviewed with clinical follow-up completed in 99% of the consecutive series. By June 2010, 285 implanted allografts had been surgically explanted, 288 patients died before allograft removal, and 267 patients are under continued follow-up.

Results

Cryopreserved aortic allografts were durable for more than 15 years in the middle-aged and older patient population. The estimated median time until structural deterioration was 20 years post-implantation, and 2 allografts have been functioning well for more than 30 years. Structural deterioration was independently related to the young age of the recipient, elderly age of the donor, severe obesity in the recipient, history of blood transfusion in the recipient, and full-root implantation technique. Infection of the implanted allograft necessitating reintervention rarely occurred. Reintervention for the allograft demonstrated 2% in-hospital mortality.

Conclusions

Cryopreserved aortic allografts were durable for more than 15 years. Structural deterioration of aortic allografts was related to multiple factors. The age of the recipient and the donor, obesity and blood transfusion history of the recipient, and implantation technique were identified as the most important factors contributing to allograft failure.
Keyword Cardiac & Cardiovascular Systems
Respiratory System
Surgery
Cardiovascular System & Cardiology
Respiratory System
Surgery
CARDIAC & CARDIOVASCULAR SYSTEMS
RESPIRATORY SYSTEM
SURGERY
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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