The reason my surgeon would use a homograft is if there is active infection. Unlike mechanical and biological valves, homograft is resistant to endocarditis.
this is quite old thinking (and was the reason I suspected he'd mentioned it). I recall reading of this shift some decade or so ago but did another search this morning to make sure. I was going to post this with my above, so I'll leave it here now for you to read and if inclined be asking him
The choice of a homograft or mechanical valve for an aortic position in active endocarditis depends on several factors, including the patient's profile, the extent of the infection, and the risk of infection recurrence:
- Patient profile: Patient preferences are a key consideration.
- Infection extent: Homografts are recommended for complex infections that involve the root or aorto-mitral continuity.
- Infection recurrence risk: The risk of infection relapse should be avoided.
Some studies have found that mechanical valves may have similar or better outcomes than homografts:
- One study found that mechanical valve-based reconstructions had similar or better short- and long-term outcomes than homografts.
- Another study found that homografts did not provide a significant benefit over conventional prosthetic valves in terms of survival or freedom from reinfection.
One of the links in that AI summary is this one:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7475423/
(from 2021)
Comparative Effectiveness of Mechanical Valves and Homografts in Complex Aortic Endocarditis
The benefit of homografts in IE remains debatable because of the lack of RCTs (
2,
3,
5-
10,
15-
18).
...
No significant differences in overall mortality and infection recurrence have been described compared to mechanical or biological substitutes in IE (
2,
3,
8,
14,
18). Klieverik
et al. (
14) reported similar recurrent endocarditis rates in homograft recipients compared to mechanical valves with lower freedom from reoperation (76%
vs. 93%, respectively). Sabik
et al. (
12) reported a 95% freedom from recurrent infection exceeding 2 years and an operative mortality of 3.9% in 103 patients with prosthetic valve endocarditis (PVE).
and
https://www.sciencedirect.com/science/article/abs/pii/S0003497520314338
Revisiting the guidelines and choice the ideal substitute for aortic valve endocarditis
(from 2020)
Results
Of 159 patients with complex active endocarditis, 48 (30.2%) had a valve plus patch reconstruction, and 85 (53.4%) had a root replacement. Of all,
50 (31.5%) had a mechanical valve, 56 (35.2%) had a bioprosthesis, and
53 (33.3%) had a homograft. The groups were similar in age, sex,
body mass index, comorbid conditions, organism, abscess location, and mitral involvement (all
P > .05). However, patients receiving mechanical reconstructions were more likely to have native valve
endocarditis (46% vs 37.5% vs 17%;
P = .005) and less likely to undergo root replacement (32% vs 28.6% vs 100%;
P < .001). Marginal risk-adjusted
operative mortality was lowest for mechanical valves (4.8%) and highest for
homografts (16.9%;
P = .041). Long-term survival after root replacement was worse with homografts than with mechanical valve conduits (adjusted hazard ratio, 2.9;
P = .045).
Conclusions
In patients with complex endocarditis, mechanical valves are associated with similar, if not better, short- and long-term outcomes compared with homografts, even after adjusting for important baseline characteristics and limiting the analysis to root replacements only.
emphasis in text mine
Best Wishes
