In this study, we showed that the use of aortic homograft in acute aortic valve endocarditis is associated with a remarkably low risk of relapsing infection and very acceptable longterm survival. The authors used the aortic root of the patient to secure the homograft aortic valve in the subcoronary position. Early history of aortic surgery journal of vascular surgery. Aortic valve homograft is when your doctor uses a human valve to replace your narrow or leaky aortic valve. This information will help you understand the conditions that may affect the aortic valve and why surgical treatment may be needed to treat your condition. An aortic homograft is a human donor aorta complete with its aortic valve. Aortic valve replacement in the setting of aortic valve endocarditis frequently is managed with an aortic homograft. An aortic homograft is an aortic valve from a human donor, retrieved either after their death or from their heart if they are undergoing a heart transplant. In 1956 gordon murray reported the use of fresh aortic valve homografts transplanted into the descending thoracic aorta for amelioration of the consequences of. Thompson r, yacoub m, ahmed m, seabragomes r, rickards a, towers m. Eighteen patients with aortic valve disease underwent aortic valve replacement, receiving a cryopreserved aortic homograft, 15 were male, 10 had aortic regurgitation, and 8 had aortic stenosis. Original article from the new england journal of medicine aorticvalve homograft in the treatment of aortic insufficiency report of nine cases, with one followed for six years.
Aortic root replacement with homograft valved conduit. Kerwins subsequent reports support the contention that aortic leaflet homograft pliability and performance were well preserved in these early patients. The commissures of the aortic homograft are pulled out of the left ventricle so that the valve assumes its normal position and configuration. Unfavorable prognosis of patients with severe and worsening heart valve disease can be successfully reversed by cardiac surgery. He had a history of aortic valve replacement with a homograft and mechanical mitral valve replacement 12 years ago for infective endocarditis. The septal muscle is excised with a finger placed inside the aorta to stabilize the graft and gauge the thickness of the trimmed graft. Readers of the journal will find interest in the article in this issue from arabkhani and colleagues1 of the erasmus university medical center in the netherlands on the longterm outcome of allografts in the aortic position. The aortic homograft needs to be slightly stretched to the recipient ascending aorta so that there is a suspensory effect to the commissural pillars of the donor valve b. However, late operation is not uncommon and may be very difficult because of calcification of the wall of the aortic homograft and the valve leaflets. Redo avr after homograft aortic root replacement can be a daunting operation but can be accomplished with good short and longterm outcomes a versatile operative strategy is required in order to deal with the calcified aortic root concern about the complexity of the subsequent redo operation should not preclude homograft use when. Homograft replacement of the aortic valve the lancet. Murray, with the implantation of an aortic homograft in the descending aorta2. Th is idea was fi rst put forward over a century ago by sir lauder brunton, who was confronted with the ineffectiveness of treatment modalities for rheumatic mitral stenosis, which was very common at the time.
The risk of reoperation due to the svd is significant after one decade especially in young patients. Factors associated with increased risk of reoperation were young age, male sex, native aortic valve insufficiency, previous aortic valve surgery, history of endocarditis, and larger homograft. From cooper to matas, 106 years were needed to obtain a successful outcome of aortic ligation for abdominal aortic aneurysms. A section of aorta from a human donor with its aortic valve intact is used to replace the aortic valve and a section of the ascending aorta. Sep 05, 2017 what is the definition of aortic valve homograft.
A 49yearold man with a history of aortic mechanical valve replacement in 2001 was referred to our hospital for treatment of infective aortic valve prosthetic endocarditis. With aortic stenosis, problems with the aortic valve make it harder for the leaflets to open and permit blood to flow forward from the left ventricle to the aorta. Stentless bioprostheses for aortic valve replacement in. Onefourth of patients with bicuspid valves will have normal valvular function and, in one natural history study, required no medical or surgical intervention at 20 years of followup. Reoperative replacement of the homograft aortic root. Aug 05, 2008 lucky for us, i just found a video that features dr.
Size of the homografts at various ages ranged from 14 to 28 mm. Bronchoaortic fistula secondary to pulmonary tuberculosis. Aortic valve surgery is performed by heart surgeons to treat most commonly bicuspid valves, other congenital aortic valve diseases, aortic valve stenosis, and aortic valve regurgitation. Feb 18, 2016 we implanted a small homograft in a small kid and the kid outgrew the graftthe cusps were absolutely normal, the conduit with no calcification at all, but there was no growth. Longterm outcomes of homografts in the aortic valve and root. Answer aortic valve homograft is when your doctor uses a human valve to replace your narrow or leaky aortic valve. Late aortic homograft valve endocarditis caused by cardiobacterium hominis. Ross, frcs harley street clinic, london, united kingdom t he history of the homograft valve can be traced back for well over 30 years, but with a few notable.
An aortic homograft is a procedure where a patient suffering the failure of aortic homograft itself receives an aortic valve intact from the human donor. Percutaneous valveinhomograft for management of a failed. Jul 01, 2005 in 1972, ross introduced the aortic homograft for replacing the infected aortic valve which was reported in 1984. This video highlights the use of the konno procedure to safely expose the root of the aorta in a patient with an aortic root abscess and a history of multiple cardiac surgeries. Aortic homografts, einstein, and complexity the journal. Redo aortic valve replacement after previous homograft. Patient outcome and valve performance following a second aortic. Ross procedure cardiothoracic and vascular surgeons. Homograft replacement of the aortic valve in cases of acute bacterial endocarditis is considered the ideal choice because of the resistance of the homograft to reinfection. Homografts were the first biological prostheses used in clinical practice to treat aortic valve stenosis in early 1960s, and they were the first stentless valves, too 1,2. Aortic root replacement using an aortic homograft was done. Historical perspective and future direction of blood vessel developments.
In all cases a cryopreserved aortic root homograft was used to replace the aortic valve and ascending aorta. He has also served as faculty on surgical symposia, teaching the implantation of the homograft and the ross procedure. Hieroglyphic texts from ancient egypt attest to the presence of aortic aneurysms millennia before the birth of christ. In most cases, aortic annuli are reduced by using various suture techniques to match the homograft. Between january 2000 and october 2006, 20 patients underwent redo surgery for aortic homograft failure in our institution. Aortic stenosis is the inability of the aortic valve to open completely.
The autograft technique harvests the patients own pulmonary valve, which is then sewn into the aortic position, and a pulmonary homograft is sewn into the pulmonary position. Longterm outcomes of homografts in the aortic valve and. Special presentation evolution of the homograft valve donald n. Aortic root enlargement and replacement with aortic homograft. Abstract longterm results with 555 aortic homografts used for isolated. The article provides almost 3 decades worth of experience with allografts in the aortic position, with important insights into 1 allograft. Consult this session to discover how to manage complex valveinvalve tavr, with a selection of clinical cases regarding severe aortic regurgitation in a degenerated aortic homograft, pure regurgitation into an invisible bentall conduit, and more. Surgeon jose navia, md, explains the rationale and details of the incorporated aortomitral homograft technique he developed as an alternative to the commando operation for severe infective endocarditis. Valveinvalve tavr in aortic homograft failure american. Longterm outcomes after autograft versus homograft aortic. This decreases the risk of reinfection, eliminates the need for blood thinning medication, and may provide superior blood circulation and valvular function.
Donald ross, an accomplished surgeon in london, was a pioneer of the aortic valve replacement using the human homograft. The first aortic homografts used as true aortic valve replacements were implanted in 1962 by donald ross in. A following ct scan showed signs of aortic ring rupture. The use of valve homografts and autografts in adult cardiac surgery. Decellularized aortic homografts for aortic valve and aorta. We are presenting our 17year clinical results of aortic root reconstruction with a cryopreserved aortic homograft in 161 patients with active aortic valve endocarditis with periannular aortic root abscess. Aortic root replacement with a novel decellularized cryopreserved. Natural history and survival in operated thoracic aortic.
Ross, frcs harley street clinic, london, united kingdom t he history of the homograft valve can be traced back for well over 30 years, but with a few notable exceptions the cardiac surgical community, after an ini tial flurry of excitement, largely ignored this development. Homograft definition of homograft by medical dictionary. Mar 26, 2019 an aortic homograft is a procedure where a patient suffering the failure of aortic homograft itself receives an aortic valve intact from the human donor. Patients undergoing avr were randomized to aortic autograft n 116 versus aortic homograft n 112. Accola uses a homograft valve to replacement the patients defective valve. Aortic surgery and anaesthesia how to do it 3rd ed.
Nearcomplete obstruction of an aortic homograft circulation. In children, these problems can include a valve that. A pulmon ary autog raft, also known as the ross procedure is wher e the ao rtic valve is removed and replaced with the patients own pulmonary valve the valve between the right ventricle and. A pulmonary autograft, also known as the ross procedure is where the aortic valve is removed and replaced with the patients own pulmonary valve the valve between the right ventricle and. The homografts were implanted with continuous 40 prolene suturefor the proximal and 50 prolene suture for the distal. If you log out, you will be required to enter your username and password the next time you visit. Aortic valve replacement johns hopkins textbook of.
In this series, longterm survival 93% at 5 years and 82% at 10 years after a second homograft aortic valve replacement was similar to that after the first homograft aortic valve replacement reported from our institution, 4 with a survival rate approaching 92% and. The recent history of aortic surgery from 1950 to the present. However, more progress has been made in the last 50 years than in the preceding 2000 years since antyllus ligated, incised, and packed his cases of aneurysms. The aortic homograft had been implanted with the root replacement technique in all patients.
Tuberculous broncho aortic fistula has not been reported, to our knowledge. Bicuspid aortic valves, and the associated aortopathy, can lead to valvular stenosis and regurgitation, as well as ascending aneurysms and dissections. Aortic valve surgery aortic homograft stanford health care. Hence, in order to close the paravalular leakage, a second tavi procedure with a core valve 26 mm was performed. Homograft technique prepares valves from human cadavers. Novel antigenreduction synergraft technology cryolife inc. History the utilisation of homografts in clinical practice began in 1956 by g. A 39yearold woman with a known history of homozygous familial hypercholesterolemia was admitted with chest discomfort. Preoperative echocardiography and coronary angiography showed a heavily stenotic aortic valve as well as a calcific hypoplastic aortic root. Accola as he works on a patient requiring aortic valve replacement due to a congenital, bicuspid aortic valve. Latest news increasing evidence for inr selfmonitoring.
Aortic root replacement with a novel decellularized. Twentytwo consecutive patients with a mean age of 64. We report a case of aortic and mitral valve bacterial endocarditis. However, the first orthotopic aortic homograft implantation of was carried out in 1962 by d. Aortic valve prosthesis endocarditis with involvement in mitral and tricuspid valve. Aortic valve prosthesis endocarditis with involvement in mitral and tricuspid valve duration.
Raajit chanana slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. An aortic root replacement is preferred when there is a geometric mismatch between the native and the homograft aortic root, because the peripheral commissures to the sinotubular junction of a scalloped undersized homograft will be overextended outwardly after freehand aortic valve replacement favr to cause central valve incompetence. When replacement of an aortic valve is necessary, it is possible to replace the valve with another human valve known as an aortic valve homograft. Aortic root reconstruction represents one of the most complex areas of cardiac surgery as well as one of the most dynamicmajor developments in understanding of the aortic root anatomy and physiology, improvements in imaging and surgical technique allowed for development and acceptance into clinical practice of several novel procedures over last couple of decades. Chest radiography showed a hyperdense aspect of the aortic annulus extending circumferentially to the aortic arch. As longterm data on the survival and quality of life of people following valve replacement have become available, evidencebased guidelines for aortic valve replacement have been developed. This video shows the technique of full root homograft replacement for active aortic valve endocarditis with annular disruption and abscess. Extended aortic root replacement 1,2 combined the techniques of aor tovcntriculoplasty z, and total aortic root replacement s using the aortic homograft. The aortic homograft is removed from the liquid nitrogen freezer used for the valve bank and thawed out by protocol method. We therefore decided to perform open heart surgery. An arterial aneurysm is defined as a localised dilation of an artery to greater than 50% of its normal diameter. Several techniques exist for decellularisation with the majority based on detergent or enzymatic protocols which aim to eliminate all donor cells while preserving the mechanical properties of the remaining matrix.
Two suture lines are necessary to assure a competent valve, one below the valve cusps, at the aortic annulus, and one above the cusps to all patients were operated upon by the authors d. The utilisation of homografts in clinical practice began in 1956 by g. This paper forms the second of a two part series on the natural history and survival of thoracic aortic aneurysms taa, in which this part focuses on patients following surgical operation. This allinone virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Aortic homograft a section of aorta from a human donor with its aortic valve intact is used to replace the aortic valve and a section of the ascending aorta. Longterm performance of 555 aortic homografts in the aortic position. The pathologic study of the pulmonary specimens showed tuberculous granulomas with caseous necrosis and tubercle bacilli in the pulmonary tissue and the fistulous area. This is a case report of a 60yearold woman with massive hemoptysis secondary to a broncho aortic fistula. Changing aspects of the natural history of valvular aortic stenosis. An aortic homogra ft is an aor tic valve from a human donor, retrieved either after their death or from their heart if they are undergoing a heart transplant. Please confirm that you would like to log out of medscape.
Homograft replacement of the calcified aortic root in. Aortic endarterectomy was popularized by wylie and by robert linton, 51 of boston. The patient was a 28yearold man with endocarditis, complicated by four prior cardiac surgeries. Repeat aortic valve replacement for failing aortic root. A radiological method of grading aortic incompetence bycine aortography is presented andthe results in the 51 patients are described. Oct 29, 2017 when replacement of an aortic valve is necessary, it is possible to replace the valve with another human valve known as an aortic valve homograft. Although no medical solution for aneurysms was available in that era, the advice allegedly given for the care of affected patients was a passionate plea, which simply stated. In the setting of severe infection, the aortic root is reconstructed using cadaveric human homograft aorta. Homograft full root replacement to treat aortic root. One patient had a history of infective endocarditis table 4. Homograft reconstruction of the aortic root for endocarditis. Redo aortic root surgery for failure of an aortic homograft. An aortic valve homograft is when a defective aortic valve is replaced with another human valve.
The use of valve homografts and autografts in adult. Top view of a fresh decellularized, nonseeded, aortic homograft with three pliable cusps. After removal of both tavi prosthesis, native valve excision a 21 mm sized aortic homograft was implanted. Aug 29, 2011 aortic root enlargement and replacement with aortic homograft amr arafat. Historical development of the use of homograft valves. The advantages of using homografts in valve replacement surgery include the excellent hemodynamic profile, good hemostasis, low risk of thromboembolism, and low risk of prosthetic valve infection 1 4. Evolution of indications, techniques, and results in 107 patients presented at the fortythird annual meeting of the southern thoracic surgical association, cancun, mexico, nov 79, 1996. Cryovalve aortic allografts are indicated for the replacement of diseased, damaged, malformed, or malfunctioning native or prosthetic aortic valves, with the option of root replacement. In 1951, aortic endarterectomy was introduced into the united states by e. Longterm followup of patients with the antibioticsterilized aortic homograft valve. Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic stenosis. The technique of homograft aortic root replacement in our practice has evolved as our experience has increased. Decellularized homografts are donated human heart valves which have been modified via tissue engineering. Patient outcome and valve performance following a second.
The first aortic homografts used as true aortic valve replacements were implanted in 1962 by donald ross in london and sir brian barrettboyes in new zealand. Over 20 years experience with aortic homograft in aortic. If you continue browsing the site, you agree to the use of cookies on this website. The advantages of using homografts in valve replacement surgery include the excellent hemodynamic profile, good hemostasis, low risk of thromboembolism, and low risk of prosthetic valve infection 14. Case report on successful bail out aortic homograft. In particular, the aortic homograft has proven its value in complex aortic root. Although women still constitute a small minority of practicing surgeons in our field today, opportunities currently abound for women in thoracic. Separate stitches are used for the right and left aortic sinuses. Aortic root replacement with pulmonary autograft in children. Women in thoracic surgery was founded in 1986, with 2016 marking its 30th anniversary. Once the distal suture line has been completed, it is easy to properly place the right coronary into the right coronary sinus of the homograft root replacement c. Top view of a fresh decellularized, nonseeded, aortic homograft. Aortic valve replacement options include homograft, stented and stentless xenograft tissue, and mechanical valves.
Aortic root replacement with a novel decellularized cryopreserved aortic homograft. Published data are limited in comparison of transcatheter aortic valve replacement with surgical aortic valve replacement for the failing aortic root homograft. Aortic root homograft in the surgical treatment of aortic. This procedure is seldom performed due to the complexity of the operation and the rapid failure of the aortic homograft itself. Historical development of the use of homograft valves springerlink. A 57yearold man with a prior medical history of hypertension, impaired fasting glucose, bicuspid aortic valve undiagnosed until adulthood, and rheumatic heart disease with reduced left ventricular ejection fraction lvef 22% at the time of presentation was admitted to the hospital with shortness of breath. Due to its complex nature of the operation, surgeons opt for aortic homograft in seldom situations. The surgical technique for insertion of a homograft aortic valve is well established 181. Aortic root reconstruction with the cryolife synergraft aortic valve homograft resulted. These help healthcare professionals decide when aortic valve replacement is the best option for a patient. Homograft implantation has been used for a variety of aortic root and aortic valve diseases. An aortic valve homograft was first used in the descending thoracic aorta for aortic regurgitation ar in 1956. So i believe decellularized aortic allografts are going to be major advances in aortic valve surgery, but it is not going to be a living graft, as the pulmonary autograft.
Aortic heart valve allografts are used to repair both congenital and acquired valvular lesions. Aortic homograft replacement in a patient with a porcelain. Combined mitral and aortic homograft valve replacement for. Longterm results after aortic valve replacement with. The sinus aorta of the homograft are attached to the host aorta by continuous suture using 40 polypropylene. The konno procedure for a redo aortic root abscess ctsnet.