Improved outcome with composite graft versus homograft root replacement for children with aortic root aneurysms

Abstract

In children with aortic root aneurysms, reoperation is more common after homograft root replacement than composite graft replacement. Composite graft root replacement provides more stable repair of the aortic root.

Aortic root replacement in children: a word of caution about valve-sparing procedures

“…In infants with a small aortic annulus, aortic root replacement using homografts has been recommended and performed with satisfactory early results. However, homografts degenerate rapidly and reoperation is inevitable and may be risky because of intense calcification of the graft [16]. This approach cannot be recommended anymore.…”

“…The late results of composite valve graft replacement are excellent in the pediatric population [13,14,16]. Our own series includes 15 patients (9 who underwent a Bentall procedure as the first operation and 6 who had the same repair after failure of a valve-sparing operation).…”

“…Twenty-three children (age 10 months to 16 1986 and 2007. Twelve patients (52%) were less than 5 years of age.…”

Combined Aortic Root and Right Ventricular Outflow Tract Replacement with Mechanical Conduits in Adult Patients after Repeated Surgery for Congenital Heart Disease

“…In general, it is not true that a mechanical prosthesis offers a "life-long" solution, because the use of mechanical valves is known to be complicated by endocarditis, thrombosis, and pannus formation, all requiring reoperations. However, considering the excellent results obtained after implantation of mechanical composite grafts in recent studies [10,11] in addition to our institutional experience, and the disappointing results after implantation of homografts [11], we believe this option is the better choice for a selected group of patients. Although early mortality from isolated aortic conduit replacement has decreased in recent decades, we noted an especial technical challenge in this setting.…”