PROSTHETIC valve replacement is associated with persistent late complications related to the mechanical nature of artificial valves.1-3 These difficulties continue to stimulate the search for better valve substitutes. Fresh aortic valve homografts have been found to be the ideal replacement for use in the subcoronary position.4 Conversely until very recently no homograft substitute was available for use in the mitral area.5-7
Our results with Starr-Edwards replacement in multiple valve disease have been reported.8 The hospital mortality in this series is within a reasonable range. Complications associated with the prolonged use of mechanical valves, however, continue to be significant. The three year morbidity and mortality at our instituion is 20% for mitral, 10% for aortic, and 25% for multiple valve replacement. Nearly all complications are related to thrombosis, embolism, or hemorrhage from anticoagulation.
Adaptation of the fresh aortic homograft for use in all intracardiac positions would alleviate