EARLY EXPERIENCE WITH HOMOGRAFT AORTIC ROOT REPLACEMENT FOR COMPLEX AORTIC PATHOLOGY

Background. Complex aortic valve and root pathology presents a serious operative challenge. Methods. During the last 45 months 21 cryopreser ved homograft root replacements have been performed in 19 patients. Th e ages of the patients ranged from 28 to 77 years; there were 15 men a nd four women. Six patients had endocarditis, four prosthetic and two native valve endocarditis. One patient underwent homograft aortic root replacement twice; one underwent concomitant homograft right ventricu lar outflow tract reconstruction for pulmonic endocarditis. Causes of aortic pathology in the other 13 patients included ascending aortic an eurysm with valvular regurgitation in seven, Marfan syndrome in two, a nd four aortic dissections with aortic regurgitation. Ten of the ninet een patients were undergoing reoperative procedures. Results. There we re three hospital deaths and one death at home of unknown cause. Two o f the three patients who died in hospital had undergone redo cardiac p rocedures. Dramatic functional class improvement was seen in all survi vors. Conclusions. Follow-up from 2 to 45 months in the fifteen surviv ors revealed no clinical or significant echocardiographic evidence of valvular regurgitation or recurrent infection. We believe homograft ro ot replacement provides an excellent method of reconstruction with sev eral advantages unique to human valved conduits, including ease of han dling, lack of synthetic nidus for recurrent infection, and absence of thrombogenic materials. Homografts should be considered the approach of choice in complex valvular and root infectious processes.