Long-term Outcomes of Aortic Valve Replacement with Aortic Homograft: 27 Years Experience

Abstract Background Aortic homografts have been used in young patients requiring aortic valve replacement(AVR). Currently, they are generally reserved for aortic valve endocarditis with or without root abscess, however, longitudinal data are lacking. Our aim was to assess the long-term safety and durability of homograft implantation. Methods All adult patients undergoing aortic homograft implantation at a single institution from 1992-2019 were included. Outcomes of interest included all-cause mortality and AV reoperation, studied over a median follow-up duration of 19 years. Results A total of 252 patients were included, with a mean age of 49 years. Infective endocarditis was the primary indication for surgery in 95(38%) patients. The endocarditis group had a higher prevalence of NYHA III-IV(56% vs. 26%), chronic kidney disease(CKD)(22% vs. 1%), prior cardiac surgery(40% vs. 10%), and emergency status(7% vs. 0%) compared to those without endocarditis(all p Conclusions Aortic homografts are associated with good long-term survival and admissible freedom from re-operation. Operative mortality is high in patients with endocarditis, however, in those who survive to discharge, long-term survival and durability are like those without endocarditis.