Repair of truncus arteriosus in early infancy with antibiotic sterilized aortic homografts

Background. To evaluate the fate of the truncal valve, the antibiotic steri lized aortic homografts, and the survival after repair of truncus arteriosu s in the first 6 months of life. Methods. Between 1974 and 1994, 23 infants (mean age 1.7 months, range 5 da ys to 6 months) underwent primary repair of truncus arteriosus by one surge on (J.L.M). Sixteen were neonates (age range 5 to 30 days). Continuity betw een the right ventricle and the pulmonary artery was established with an ao rtic antibiotic sterilized homograft (mean diameter 14.9 mm, range 11 to 17 mm). Follow-up was 100% complete. Results. Four neonates with severe truncal regurgitation died early (17.4%) . Fourteen patients underwent reoperations. Five had a truncal valve replac ement (mean time 7 years, range 6 months to 17 years). Ten-year freedom fro m truncal valve replacement was 78.2%. Eleven patients had homograft replac ement (mean time 12.7 years, range 2 to 26.2 years). Ten-year freedom from homograft replacement for any cause was 77.1% (for homograft-related proble ms it was 86.7%). Seven patients retained the original homografts (mean tim e 14.3 years, range 6 to 18.7 years). There was one late death. Overall 10- year survival was 79% and for the hospital survivors it was 95%. All surviv ors are in New York Heart Association functional class I. Conclusions. Abnormal truncal valves pose serious early and late problems b ut the patients with normal truncal valves do well and seem unlikely to nee d replacement of these valves. The durability of the antibiotic sterilized aortic homograft even in sizes less than 14 mm is remarkably good. Late sur vival is excellent. (C) 2001 by The Society of Thoracic Surgeons.