Surgical options and results of repeated aortic root replacement for failed aortic allografts placed in childhood.
OBJECTIVE
This report reviews our experience with repeated aortic root replacement after failure of cryopreserved aortic allografts placed during childhood and compares replacement with aortic allografts, pulmonary autografts, and mechanical valved conduits in these patients.


METHODS
This was a retrospective analysis of all such patients from 1986 through May 2001.


RESULTS
There were 25 operations (11 aortic allografts, 9 pulmonary autografts, and 5 mechanical valved conduits) among 23 patients. The mean time to reoperation was 6.3 years. There were 2 in-hospital deaths (8%, 1 patient with a pulmonary autograft and 1 with a mechanical valved conduit). There were 2 early nonfatal valve-related events (1 patient with an aortic allograft and 1 with a pulmonary autograft). There were no late valve-related deaths and 2 late non-valve-related deaths of patients with aortic allografts placed. No variable predicted early death or early valve-related event. No differences in preoperative characteristics, hospital variables, early outcomes, or late outcomes were detected among the groups. Overall, 19 patients are alive (18 in New York Heart Association functional class I and 1 in New York Heart Association functional class III) at a mean follow-up of 49 months. Two late aortic allograft failures necessitated reoperation. All patients with successful pulmonary autografts had excellent autograft function at a mean follow-up of 68 months. All early survivors with mechanical valved conduits are alive and free of valve-related events (mean follow-up 71 months). Five-year freedoms from valve-related death or event (Kaplan-Meier) were 84% for all patients, 91% for aortic allografts, 78% for pulmonary autografts, and 80% for mechanical valved conduits (no statistically significant group differences by log-rank test).


CONCLUSIONS
Replacement of cryopreserved aortic root allografts placed during childhood is safe. Five-year pulmonary autograft durability is excellent, although the risk of early failure may be increased. Differences in 5-year conduit longevity were not detectable.
Mitchell
Max B
MB
Division of Cardiothoracic Surgery, University of Colorado Health Sciences Center and The Children's Hospital, Denver, Colo. 80218, USA. mitchell.max@tchden.org
Campbell
David N
DN
Bishop
Deborah A
DA
Mackenzie
Todd
T
Clarke
David R
DR
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000473:pathology / Q000637:transplantation*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003120:Colorado; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000401:mortality / Q000601:surgery