Hi Chuck and good morning from Australia
to extend what you've answered to
@Redone
On the other hand, homografts will often last 20 years or more. @pellicle had a homograft and it lasted about 18 years. I believe his valve was still ok at the time, but they had to operate due to an aneurysm, so they replaced the valve at the time as well.
yes, that's right, my first surgery (at 10) was a fix, my second at 28 was a homograft. I was fortunate that in Queensland our primary cardiac hospital had a great interest in homografts which (if I understood correctly) was sufficiently world class as to have done surgeries on US heart surgeons.
From my collected notes on the literature reading I did on that:
https://pubmed.ncbi.nlm.nih.gov/11380096/
The homograft aortic valve: a 29-year, 99.3% follow up of 1,022 valve replacements.
RESULTS:
The 30-day/hospital mortality was 3% overall, falling to 1.13 +/- 1.0% for the 352 homograft root replacements.
Actuarial late survival at 25 years of the total cohort was 19 +/- 7%.
Early endocarditis occurred in two of the 1,022 patient cohort, and freedom from late infection (34 patients) actuarially at 20 years was 89%. One-third of these patients were medically cured of their endocarditis.
Preservation methods (4 degrees C or cryopreservation) and implantation techniques displayed no difference in the overall actuarial 20-year incidence of late survival endocarditis, thromboembolism or structural degeneration requiring operation.
Thromboembolism occurred in 55 patients (35 permanent, 20 transient) with an actuarial 15-year freedom in the 861 patients having aortic valve replacement +/- CABG surgery of 92% and in the 105 patients having additional mitral valve surgery of 75% (p = 0.000).
Freedom from reoperation from all causes was 50% at 20 years and was independent of valve preservation.
Freedom from reoperation for structural deterioration was very patient age-dependent. For all cryopreserved valves, at 15 years, the freedom was
⦁ 47% (0-20-year-old patients at operation),
⦁ 85% (21-40 years),
{I was in this group as I was 28 at surgery}
⦁ 81% (41-60 years) and
⦁ 94% (>60 years). Root replacement versus subcoronary implantation reduced the technical causes for reoperation and re-replacement (p = 0.0098).
CONCLUSION:
This largest, longest and most complete follow up demonstrates the excellent advantages of the homograft aortic valve for the treatment of acute endocarditis and for use in the 20+ year-old patient. However, young patients (< or = 20 years) experienced only a 47% freedom from reoperation from structural degeneration at 10 years such that alternative valve devices are indicated in this age group.
The overall position of the homograft in relationship to other devices is presented.
to this date I've never seen any study as lengthy or as complete emerging from the USA or anywhere actually. The (once well known ) Edinburgh study of mechanical was of lower count of patients (533 ) and of a shorter duration of follow-up.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767707/
The Edinburgh heart valve study of 533 patients, who had their valve implant(s) between 1975 and 1979, now reports comparative clinical outcome for mechanical versus bioprosthetic valves at 20 years.1 The present report supplements a 12 year follow up, published in 1991.2 The original study was prospective and randomised. The study design was modified in January 1977 in those patients randomised to receive a porcine bioprosthesis. Initially, the porcine valve used was the Hancock prosthesis, but, after January 1977, the Carpentier-Edwards valve was used because of its “substantial cost advantage”.
