Own valve trumps donor valve for aortic valve replacement
MedWire News: Using patients' own pulmonary valves rather than aortic valves from deceased donors improves their long-term survival and quality of life after aortic valve replacement, report UK researchers.
The use of an autograft for an aortic root replacement, an operation known as the Ross procedure, "is the only operation with which long-term viability of the aortic root is guaranteed, which could explain the enhanced survival in this study," say Magdi Yacoub (Royal Brompton and Harefield NHS Trust, London) and team.
The team assessed the 10-year survival rates of 216 patients randomly allocated to undergo aortic root replacement using a homograft from a deceased donor (n=108) or an autograft from their own pulmonary valve (n=108) from September 1994 through May 2001.
The patients' quality-of-life was also evaluated using the Short-Form 36 health survey (SF-36) questionnaire, which was completed by each patient toward the end of the study (2008).
The findings, reported in The Lancet, show that few patients died perioperatively, irrespective of graft type, at a rate of <1% and 3% among patients in the autograft and homograft groups, respectively (p=0.6215).
After 10 years, a higher survival rate was found among the patients who received an autograft compared with those who received a homograft, at 97% and 83%, respectively (p=0.002).
Interestingly, the team also reports that the 97% survival rate achieved with autograft was very similar to the 96% survival rate observed in an age- and gender-matched heart disease-free UK population.
Only 75% and 71% of the patients in the autograft and homograft groups, respectively, completed a SF-36 questionnaire. Their results showed that general health and physical functioning scores were, respectively, 2.5 and 3.9 points higher among the autograft group than the homograft group, with higher scores reflecting a higher self-reported quality of life.
Similarly, more patients in the autograft group than in the homograft group did not need reoperations at 10 years, at 95% and 82%, respectively (p<0.0001).
In an accompanying commentary, Salvatore Lentini (Policlinico Universitario G Martino, Messina, Italy) concluded that despite the promising results of this study, the great surgical demand for the autograft procedure would most likely prevent its widespread use.
He added: "Continued research will probably soon help in the identification of living aortic valve substitutes… with the aim of increasing technique reproducibility and allowing more widespread use."
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By Lauretta Ihonor