Abstract

GAGO, Otto. Reemplazo de la válvula aórtica con homoinjertos valvulares. Gac Méd Caracas [online]. 2006, vol.114, n.3, pp.190-197. ISSN 0367-4762.

Between 1989 and 2005 aortic valve homografts were done in 212 patients. The surgical techniques used were the classical Ross or subcoronarian implantation in 36 patients with an average age of 54 years old. Thirty one of these patients had stenosis or aortic insufficiency and 5 of them had endocarditis. The aortic root replacement technique was performed in 174 patients with an average age of 62 years old. The majority of them had complex pathologies, such as ascending aortic aneurysm, acute or chronic dissections, native and prosthetic endocarditis, annular destruction and outlet tract abscesses. The initial results were evaluated by transoperatory echocardiography and long term assessments were made by yearly echos. There were no mortality, endocarditis or re-intervention cases in the subcoronarian group during the first 4 years of evolution. In the root replacement group there was a 10.9 % hospital mortality, always related to the complex pathology intervention. There were no additional complications in the survivors during the first 3 years of evolution. The ventricular mass regression was more significant in the second group, with 26 % reduction in the first year, while the ventricular mass reduction was 11% in the first group during the same time. The subcoronorian technique had no mortality cases but it is more difficult and more residual insufficiency occurred. At the contrary, the aortic root replacement technique is more reproducible and is less influential on early insufficiency. However, the mortality is higher due to the complexity of the pathology and the magnitude of the procedure. At the present time indications have been reduced to attend patients with endocarditis, complex aortic reconstruction in older people (aneurysms, abscesses), other biological valve contraindications, small aortic ring and patients with anticoagulant contraindications.