SYSTEMIC HYPERTENSION AFTER HOMOGRAFT AORTIC VALVAR REPLACEMENT A CAUSE OF LATE HOMOGRAFT FAILURE

Abstract

116 patients undergoing successful aortic valvar replacement with an irradiated homograft valve have been followed up for periods of 6 months to 51/2 years. 39 of the patients (34%) have developed a diastolic pressure of greater than 90 mm. Hg, and in all but 1 of these the diastolic pressure exceeded 100 mm. Hg. In 4 patients hypertension was first noted in the immediate postoperative period, but the prevalence then rose until 53% were hypertensive 5 years after surgery. Neither preoperative hypertension nor impaired renal function were significantly associated with the development of postoperative hypertension. The frequency of hypertension in males (39%) was significantly greater than in females (15%), and patients with preoperative aortic regurgitation developed hypertension more frequently (50%) than those with dominant aortic stenosis (27%). The presence of hypertension was a major determinant of late failure of the irradiated homograft. Significant regurgitation has occurred in 14% of the patients and necessitated reoperation in 4·3%. In the patients with hypertension before starting hypotensive treatment the incidence of homograft failure was 40%, as compared to 8% in the normotensive group (P<0·02). The incidence of valvar failure in hypertensive patients receiving hypotensive therapy was 11%, which did not significantly differ from the normotensive group. Systemic hypertension is a common late complication of homograft aortic valvar replacement and requires early treatment to reduce the risk of valvar failure.