Replacement of the aortic valve with cryopreserved aortic allograft.

Replacement of the aortic valve with cryopreserved aortic allograft was performed in 88 patients during the period from July 1985 until January 1993. Age of patients ranged from 15 to 75 years (mean, 44 years). The cause of aortic valve disease was congenital in 39 (44%), rheumatic in 9 (10%), degenerative in 14 (16%), endocarditis in 11 (13%), and failed prosthesis in 15 (17%). The operation was performed by freehand allograft technique in 71 patients (81%). There were no perioperative deaths. Two patients died later at 4 months and 5 years after operation (actuarial survival = 94% at 7.5 years). Follow-up extending to 7.5 years shows 87% of patients are in New York Heart Association functional class I. No thromboembolism has been detected in any patient. Infection was cured in all patients with endocarditis. Mild aortic valve incompetence was detected by diastolic murmur in 45% of patients. Only three valves have been removed at reoperation: one was removed early for technical reasons, and two valves were removed for structural degeneration at 33 and 55 months; the latter was infected. Actuarial freedom from reoperation for any reason was 89%; for structural deterioration it was 93% at 7.5 years. Aortic valve replacement with cryopreserved aortic allograft can be safely performed in adult patients. Medium-term results show excellent freedom from thromboembolism and cure of bacterial endocarditis. Mild aortic valve incompetence is often present, but reoperation for progressive incompetence is unusual.