HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Max B. Mitchell David N. Campbell David R. Clarke Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mitchell, M. B. Articles by Clarke, D. R. Search for Related Content PubMed PubMed Citation Articles by Mitchell, M. B. Articles by Clarke, D. R. Related Collections Great vessels Valve disease

J Thorac Cardiovasc Surg 2002;124:459-470
© 2002 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Surgical options and results of repeated aortic root replacement for failed aortic allografts placed in childhood

From the Division of Cardiothoracic Surgery^a and the Department of Preventative Medicine and Biometrics,^b University of Colorado Health Sciences Center and The Children's Hospital, Denver, Colo.

Read at the Twenty-seventh Annual Meeting of The Western Thoracic Surgical Association, San Diego, Calif, June 20-23, 2001.

Received for publication June 28, 2001. Revisions requested Oct 10, 2001; revisions received Dec 4, 2001. Accepted for publication Dec 18, 2001. Address for reprints: Max B. Mitchell, MD, The Children's Hospital, 1056 E 19th Ave, B200. Denver, CO 80218 (E-mail: mitchell.max{at}tchden.org).

Objectives: 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.

This article has been cited by other articles:

				T. M. Joudinaud, F. Baron, R. Raffoul, B. Pagis, M. Vergnat, C. Parisot, U. Hvass, and P. R. Nataf Redo aortic root surgery for failure of an aortic homograft is a major technical challenge Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 989 - 994. [Abstract] [Full Text] [PDF]

				K. R. Kanter, P. M. Kirshbom, and B. E. Kogon Redo Aortic Valve Replacement in Children Ann. Thorac. Surg., November 1, 2006; 82(5): 1594 - 1597. [Abstract] [Full Text] [PDF]