In order to compare the long-term outcome of stented vs stentless aortic xenografts, a non-randomized, concurrent case-match trial was conducted on all consecutive patients operated between January 1992 and April 2000. There were 31 late deaths. Associated lesions were present in 10 (38%) patients, including three cases of major coronary artery anomalies such as origin of the circumflex from the right coronary sinus, high origin of the right coronary, aneurysmal and calcified right and left main coronaries, both in one patient. Direct heterograft valve implantation was, therefore, abandoned in favor of stented bioprostheses, which are easier to implant and provide more reproducible results. A case-match analysis identified 113 identical patient pairs, on the basis of age, gender, diagnosis, NYHA class, associated cardiac disease, and valve size. There were no perioperative or late deaths at follow-up (range, 2 to 25 months; mean, 13.5 +/- 8 months). Congenital valve disease (CVD) occurs in isolated form or as part of complex malformations and presents distinct epidemiology, including: young age at onset; high prevalence of associated pathology; history of prior operations; critical clinical presentation. Autografts and homografts are the preferred replacement aortic valves for these patients even if concomitant mitral valve replacement is required, and risk of valve-related death or recurrent endocarditis is low at medium-term follow-up. There were no episodes of infective endocarditis, and no reoperations on the aortic root were necessary. Aortic-valve allografts and porcine bioprostheses, which do not necessitate anticoagulant therapy, may deteriorate and have limited durability. Freedom from structural deterioration (99 +/- 1 vs 98 +/- 2%, p = 0.7) and from reoperation (99 +/- 1 vs 95 +/- 3%, p = 0.2) at 8 years was similar. One patient died suddenly 13 months after ARR; hence actuarial survival rate was 100% and 96% at 12 and 24 months, respectively. When used for burn treatment, a homograft is a skin graft from a cadaver. In addition, stentless xenografts have shown extreme versatility when adopted in a variety of complex clinical conditions associated with aortic valve disease, including small aortic anulus, ascending aortic aneurysm, endocarditis and left ventricular dysfunction. The optimal surgical treatment of complex (multiple level or recurrent) left ventricular outflow tract obstruction (LVOTO) in infancy is controversial. Intermediate follow-up indicates satisfactory function of the autografts, with no dilatation or progressive valvular regurgitation. A recent echocardiographic study was available in 124 patients (71.3%). Methods: Bioprostheses, also known as heterografts or xenografts, are tissue valves constructed from porcine or bovine tissue. We examined the relation between enlargement of the pulmonary autograft and the development and progression of neo-aortic valve regurgitation, and the long-term clinical follow-up, including the need for reoperation, in patients followed for up to 13 years postoperatively. Brief discussions will be presented regarding hemodynamics, child-bearing, endocarditis, and the use of the Ross in pediatric patients as well as biological adaptability of the living pulmonary autograft. Multivariate analysis showed younger age (p = 0.05), preoperative aortic root dilatation (p = 0.02), root replacement technique (p = 0.03), and absence of pericardial strip buttressing (p = 0.04) to be predictive of autograft dilatation. Freedom from reoperation at 7 years was 96.7%. The hand and arm were the first areas to be grafted with split skin Autografts taken from my thighs and were completely successful. Regurgitation was not more than trivial for any of the implanted valves. Four (2.36%) patients required intraoperative aortic counterpulsation. The homograft annulus diameter decreased by a mean of 10% (range 3 to 10 mm; p < 0.01), and peak Doppler gradient increased significantly (p < 0.001). Early mortality was higher in group 1 (6.2% vs 2.6%, p = 0.02). Although treatments by autogenic and allogenic tissue transplantation have been successfully applied in clinical procedures for numerous medical conditions, these therapies are largely impeded by their disadvantages, such as the limited tissue available, considerable donor site morbidity and risks of disease transmission [140,162, ... Homograft is used when both the donor and the recipient of the cell have tissue or the organ belongs to one biological species, despite their genetic differences. A smaller indexed effective orifice area (p = 0.0008), chronic obstructive pulmonary disease (p = 0.015), and implantation of a conventional stented bioprosthesis or mechanical valve (p = 0.016) were related to reduced LVEF recovery by univariate analysis. At 7 years, freedom from dilatation was 42+/-8%, freedom from regurgitation was 75+/-8%, and freedom from reoperation was 85+/-10%. Three (0.8%) hospital deaths occurred (vs. 1.9% AVD, p = 0.2) due to endocarditis. Twenty-three pediatric xenograft (size 10 to 21 mm) recipients were compared with 23 homograft (size 9 to 21 mm) recipients.Results. The pulmonary valve and artery were replaced with a cryopreserved pulmonary allograft. Early dilatation of the pulmonary autograft root exposed to the systemic circulation has been reported. On actuarial analysis, freedom from significant incompetence for the entire group was 95% at 5 years, 78% at 10 years, and 42% at 14 years. Two of the latter patients presented with intraoperative right ventricular ischemia due to kinking of the right coronary (corrected by re-implantation at a higher level), and one had intraoperative hemorrhage due to rupture of a calcified left main coronary, which required transection of the pulmonary homograft above the valve to expose the tear. 1984 were identified and their outcomes determined to 1994. The new stentless xenograft valves do not have these prosthestic stents, allowing for larger valves to be implanted than if a stented bioprosthesis is used. Rates of reintervention were similar at 7% (2 of 26) for cryopreserved allografts and 3.8% (1 of 26) for SynAs (p = 0.98). Also known as an allogeneic graft or a homograft. Results: Despite higher prevalence of associated procedures, reoperation and emergent indication, operative risk in CVD is lower than in AVD, possibly because of younger age. Stentless valves are more likely to be replaced for dysfunction. Twenty-six patients (7.0% vs. 10.8% AVD, p = 0.003) experienced complications (cardiac, 7; neurologic, 6; respiratory, 5; renal, 3; sepsis/multiple organ failure (MOF), 2; hemorrhage, 8). Due to greater technical complexity of the operation, complications with autograft root replacement (ARR) may be more common. In those studied with MRI, there was evidence of narrowing of the whole homograft or distal suture line in 14 of 15 patients, with obvious excess surrounding tissue in 11.
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