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CLINICAL STUDIES

Hemodynamic performance of cryopreserved aortic homograft valves during midterm follow-up

^a Division of Clinical Physiology, Karolinska Hospital Department of Surgical Sciences, Karolinska Institute, Stockholm, Sweden
^b Division of Thoracic Surgery, Karolinska Hospital Department of Surgical Sciences, Karolinska Institute, Stockholm, Sweden

Manuscript received December 17, 1997; revised manuscript received April 3, 1998, accepted June 4, 1998.

Address for correspondence: Dr. Maria Eriksson, Department of Clinical Physiology, Karolinska Hospital, S-17176 Stockholm, Sweden
mer{at}thfys.ks.se

Objectives. The aim of this prospective study of adult patients operated with a cryopreserved aortic homograft was to use serial echocardiographic data to evaluate the postoperative hemodynamic performance of these valves.

Background. Only limited data on hemodynamic performance of aortic homografts at rest and during exercise are available. Controversy also exists regarding incidence and progression of aortic regurgitation (AR).

Methods. Fifty-nine patients aged 39–86 years who received an aortic homograft (median size 21 mm) implanted with subcoronary technique were studied with serial Doppler-echocardiography (D-E). In 31 of these patients, D-E also was performed during supine exercise.

Results. Overall survival was 100% during a median follow-up of 28 months (range 4–54). During follow-up AR grade II or more was detected in 25% of the patients with an increasing time-related risk of developing AR. Maximum and mean pressure differences at 7 months follow-up calculated with the short form of the Bernoulli equation were 11.4 (4.6) and 5.5 (2.1) mm Hg, respectively. During supine exercise that increased cardiac output 72%, maximum pressure difference increased from 11.9 (5.2) to 18.5 (9.5) mm Hg.

Conclusions. The aortic homograft valve shows low pressure differences at rest and during exercise, but AR grade I or II is often seen during follow-up. As AR progresses with time we stress the importance of echocardiographic follow-up of patients with aortic homografts.

Abbreviations and Acronyms   AR = aortic regurgitation   D-E = Doppler echocardiography   NYHA = New York Heart Association   Pmax = maximum pressure difference   Pmean = mean pressure difference   EF = ejection fraction   EOA = effective orifice area   CO = cardiac output   AVF = aortic valve volume flow   BSA = body surface area   VAO = velocity across the aortic homograft   VLVOT = velocity in the left ventricular outflow tract

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