NONVALVED HOMOGRAFTS OF THORACIC AORTA IN OPERATION FOR COMPLEX CONGENITAL CARDIAC DISEASE

Background. In contrast to the wide and successful use of valved aorti c and pulmonary homografts, the non-valved prolongation of the thoraci c aorta for the repair of some complex congenital heart diseases has r arely been described. We present here our experience with the use of d escending aorta and aortic arch homografts as non-valved conduits for the surgical repair of complex cardiac malformations in 8 patients. Me thods. One atriopulmonary conduit replacement, four extraatrial cavopu lmonary connections, and one intraatrial cavopulmonary repair were ach ieved by means of a homograft of the descending aorta with a diameter of 15 to 17 mm. Three pulmonary unifocalization procedures were carrie d out in 2 more patients using a curved homograft of the aortic arch w ith a diameter of 18 mm. Except for 1 patient, whose incompetent commo n atrioventricular valve was replaced with a mechanical prosthesis, al l other patients were managed without anticoagulation.Results. No cond uit-related complications were seen during a follow-up of 18 to 42 mon ths. One patient died perioperatively during an emergency central repa ir of the right ventricular outflow tract after bilateral unifocalizat ion with arch homografts. Another patient died suddenly 4 months after cavopulmonary connection. The remaining 6 patients are currently doin g well. Conclusions. Regardless of the complexity of the underlying ma lformations, we are encouraged to use non-valved thoracic aortic homog rafts in the repair of congenital cardiac diseases because of the redu ction in thrombotic, hemorrhagic, and infectious complications associa ted with their use; convenience in handling; and their versatility in size and shape.