HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ruyun Jin Gary L. Grunkemeier Donald N. Ross Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Athanasiou, T. Articles by Ross, D. N. Search for Related Content PubMed PubMed Citation Articles by Athanasiou, T. Articles by Ross, D. N. Related Collections Valve disease Related Article

Ann Thorac Surg 2006;81:1578-1585
© 2006 The Society of Thoracic Surgeons

---

Original article: Cardiovascular

Homograft Implantation Techniques in the Aortic Position: To Preserve or Replace the Aortic Root?

^a Imperial College of Science, Technology and Medicine, Department of Surgical Oncology and Technology, St. Mary's Hospital, London, United Kingdom
^b Providence Health System, Portland, Oregon

Accepted for publication December 13, 2005.

^_* Address correspondence to Dr Athanasiou, 70 St Olaf's Road, Fulham, London SW6 7DN, United Kingdom (Email: tathan5253{at}aol.com).

BACKGROUND: One determinant of durability of the homograft in the aortic position is the implantation technique. This study uses meta-analytical techniques to evaluate the differences in early and long-term outcomes of patients undergoing aortic homograft implantation with either a root replacement or a root preserving technique.

METHODS: A systematic review of the literature (1965–2005) reporting results after homograft implantation in the aortic position with emphasis in the implantation technique was performed. Random and fixed-effects models were used. Cumulative and influential meta-analysis, graphic exploration, and sensitivity analysis were carried out to explain the heterogeneity between studies and to investigate potential publication bias.

RESULTS: Eleven studies were included. None of the studies was randomized. There was no significant difference in early mortality between root replacement and root preserving groups (odds ratio = 2.57 with 95% confidence interval [CI] 0.68–9.72 in random-effects model) and the root replacement group had a significantly lower rate of reoperation during long-term follow-up (hazard ratio = 0.55 with 95% CI 0.38–0.80 in random-effects model). Subgroup analysis focusing on patients having the subcoronary technique for homograft implantation showed similar results. Significant heterogeneity between studies can be detected. No publication bias was found.

CONCLUSIONS: There was no significant difference in early mortality between root replacement and root preserving groups. However, the root replacement technique group had a significantly lower rate of reoperation during long-term follow-up. Excluding outliers identified in a funnel plot reduced the heterogeneity and reached a similar conclusion.

Related Article

Invited commentary

Tirone E. David
Ann. Thorac. Surg. 2006 81: 1585-1586. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				A. Ali, Y. Abu-Omar, A. Patel, Z. Ali, A. Y. Sheikh, A. Akhtar, A. Pavlovic, P. Theodorou, T. Athanasiou, and J. Pepper Valve failure following homograft aortic valve replacement: does implantation technique have an effect? Eur. Heart J., June 1, 2008; 29(11): 1454 - 1462. [Abstract] [Full Text] [PDF]

				T. Athanasiou, A. Chow, C. Rao, O. Aziz, F. Siannis, A. Ali, A. Darzi, and F. Wells Preservation of the mitral valve apparatus: evidence synthesis and critical reappraisal of surgical techniques Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 391 - 401. [Abstract] [Full Text] [PDF]

				J.-F. Avierinos, F. Thuny, V. Chalvignac, R. Giorgi, L. Tafanelli, J.-P. Casalta, D. Raoult, T. Mesana, F. Collart, D. Metras, et al. Surgical Treatment of Active Aortic Endocarditis: Homografts Are Not the Cornerstone of Outcome Ann. Thorac. Surg., December 1, 2007; 84(6): 1935 - 1942. [Abstract] [Full Text] [PDF]

				J. J.M. Takkenberg, L. M.A. Klieverik, J. A. Bekkers, A. P. Kappetein, J. W. Roos, M. J.C. Eijkemans, and A. J.J.C. Bogers Allografts for aortic valve or root replacement: insights from an 18-year single-center prospective follow-up study Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 851 - 859. [Abstract] [Full Text] [PDF]

				R.-U. Kuehnel, U. A. Stock, M. O. Wendt, I. Degenkolbe, U. Jainski, M. Hartrumpf, M. Pohl, and J. M. Albes Physiological function of stentless aortic valves is altered by trimming and removal of aortic wall components Interactive CardioVascular and Thoracic Surgery, April 1, 2007; 6(2): 182 - 187. [Abstract] [Full Text] [PDF]

				T. E. David Invited commentary. Ann. Thorac. Surg., May 1, 2006; 81(5): 1585 - 1586. [Full Text] [PDF]