Hans-Hinrich Sievers1, Ulrich Stierle2, Efstratios I Charitos2, Johanna J M Takkenberg3, Jürgen Hörer4, Rüdiger Lange4, Ulrich Franke5, Marc Albert5, Armin Gorski6, Rainer G Leyh6, Arlindo Riso7, Jörg Sachweh7, Anton Moritz8, Roland Hetzer9, Wolfgang Hemmer10. 1. Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany hans-hinrich.sievers@uk-sh.de. 2. Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany. 3. Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. 4. Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany. 5. Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany. 6. Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany. 7. Paediatric Cardiology/Paediatric Cardiac Surgery, University Heart Center, Hamburg, Germany. 8. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany. 9. Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany. 10. Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany.
Abstract
OBJECTIVES: Conventional aortic valve replacement (AVR) in young, active patients represents a suboptimal solution in terms of long-term survival, durability and quality of life. The aim of the present work is to present an update on the multicentre experience with the pulmonary autograft procedure in young, adult patients. METHODS: Between 1990-2013, 1779 adult patients (1339 males; 44.7 ± 11.6 years) underwent the pulmonary autograft procedure in 8 centres. All patients underwent prospective clinical and echocardiographic examinations annually. The mean follow-up was 8.3 ± 5.1 years (range 0-24.3 years) with a total cumulative follow-up of 14 288 years and 662 patients having a follow-up of at least 10 years. RESULTS: The early (30-day) mortality rate was 1.1% (n = 19). Late (>30 day) survival of the adult population was comparable with the age- and gender-matched general population (observed deaths: 101, expected deaths: 91; P = 0.29). Freedom from autograft reoperation at 5, 10 and 15 years was 96.8, 94.7 and 86.7%, respectively, whereas freedom from homograft reoperation was 97.6, 95.5 and 92.3%, respectively. The overall freedom from reoperation was 94.9, 91.1 and 82.7%, respectively. Longitudinal modelling of functional valve performance revealed a low (<5%) probability of a patient being in higher autograft regurgitation grades throughout the first decade. Similarly, excellent homograft function was observed throughout the first 15 years. CONCLUSION: The autograft principle results in postoperative long-term survival comparable with that of the age- and gender-matched general population and reoperation rates within the 1%/patient-year boundaries and should be considered in young, active patients who want to avoid the shortcomings of conventional prostheses.
OBJECTIVES: Conventional aortic valve replacement (AVR) in young, active patients represents a suboptimal solution in terms of long-term survival, durability and quality of life. The aim of the present work is to present an update on the multicentre experience with the pulmonary autograft procedure in young, adult patients. METHODS: Between 1990-2013, 1779 adult patients (1339 males; 44.7 ± 11.6 years) underwent the pulmonary autograft procedure in 8 centres. All patients underwent prospective clinical and echocardiographic examinations annually. The mean follow-up was 8.3 ± 5.1 years (range 0-24.3 years) with a total cumulative follow-up of 14 288 years and 662 patients having a follow-up of at least 10 years. RESULTS: The early (30-day) mortality rate was 1.1% (n = 19). Late (>30 day) survival of the adult population was comparable with the age- and gender-matched general population (observed deaths: 101, expected deaths: 91; P = 0.29). Freedom from autograft reoperation at 5, 10 and 15 years was 96.8, 94.7 and 86.7%, respectively, whereas freedom from homograft reoperation was 97.6, 95.5 and 92.3%, respectively. The overall freedom from reoperation was 94.9, 91.1 and 82.7%, respectively. Longitudinal modelling of functional valve performance revealed a low (<5%) probability of a patient being in higher autograft regurgitation grades throughout the first decade. Similarly, excellent homograft function was observed throughout the first 15 years. CONCLUSION: The autograft principle results in postoperative long-term survival comparable with that of the age- and gender-matched general population and reoperation rates within the 1%/patient-year boundaries and should be considered in young, active patients who want to avoid the shortcomings of conventional prostheses.
Authors: Amine Mazine; Rodolfo V Rocha; Ismail El-Hamamsy; Maral Ouzounian; Bobby Yanagawa; Deepak L Bhatt; Subodh Verma; Jan O Friedrich Journal: JAMA Cardiol Date: 2018-10-01 Impact factor: 14.676
Authors: Francesco Nappi; Sanjeet Singh Avtaar Singh; Mario Lusini; Antonio Nenna; Ivancarmine Gambardella; Massimo Chello Journal: Ann Transl Med Date: 2019-09
Authors: William H Ryan; John J Squiers; Katherine B Harrington; Tammy Goodenow; Courtney Rawitscher; Justin M Schaffer; J Michael DiMaio; William T Brinkman Journal: Ann Cardiothorac Surg Date: 2021-07
Authors: Campbell D Flynn; Joshua H De Bono; Benjamin Muston; Nivedita Rattan; David H Tian; Marco Larobina; Michael O'Keefe; Peter Skillington Journal: Ann Cardiothorac Surg Date: 2021-07
Authors: Johanna Schlein; Barbara Elisabeth Ebner; Ralf Geiger; Paul Simon; Gregor Wollenek; Anton Moritz; Andreas Gamillscheg; Eva Base; Günther Laufer; Daniel Zimpfer Journal: Interact Cardiovasc Thorac Surg Date: 2021-08-18