The versatile homograft and autograft valve.

n this report I am using the old accepted term homograft I rather than the more fashionable ullogruft, and I would suggest that the following be made clear about valve terminology. True biological valves have no man-made additions or distortions. So-called biological valves are hybrid creations of plastic, steel, and tanned leather and are appropriately called bioprostheses. They combine the virtues and disadvantages of biological and prosthetic valves. My colleagues and I inserted our first homograft aortic valve freehand in June 1962 [l], within a year of the first mechanical Starr valve, which shares with it the distinction of over 20 years of follow-up. It is appropriate to remind ourselves that all valves (mechanical, biological, and bioprosthetic) are splendid for the first 7 years, so that a realistic appraisal of a valve’s performance only becomes relevant after 10 years. The advantages and disadvantages of the homograft are well known. Among the former is the total absence of emboli and the need for anticoagulant therapy with its attendant dangers. Other advantages have come to light, such as the virtual absence of sudden deaths, and the average lifespan of homografts before removal is certainly longer in our hands than that of their bioprosthetic counterparts. Other advantages include the low incidence of endocarditis, their successful application to young children, and their versatility in being applicable at all valve sites. Quality of life is difficult to define and does not easily fall within the criteria that can be subjected to the newly introduced guidelines for the presentation of valve data. Nevertheless, all my aortic homograft patients, with one exception, when faced with a second operation, have asked for another homograft. Without presenting a series of complex actuarial analyses relating to valve function, I would say that patient survival (which is what our patients are interested in and what should also be our primary concern) is better in our hands with a homograft than a mechanical valve (Fig