SURGICAL REPAIR OF TRUNCUS ARTERIOSUS WIT H HOMOGRAFTS - SHORT AND MEDIUM-TERM RESULTS

Between July 1987 and July 1993, 25 consecutive children with truncus arteriosus underwent complete surgical correction with homografts. Nin eteen were under 6 months of age and 4 had an associated interruption of the aortic arch. Ten pulmonary and fifteen aortic homografts were i mplanted. They were cryopreserved with the exception of two, fresh aor tic homografts. The diameters of the homografts varied from 8 to 19 mm s. Two children who had an interruption of the aortic arch, aged 24 an d 31 days, died in the peroperative period. The postoperative course w as uncomplicated in only 3 cases; 20 patients had complications, inclu ding 9 cardiogenic shocks and 8 pulmonary hypertensive crises. The med ium-term results included one death 4 months after surgery in an infan t with an interruption of the aortic arch, and 2 successful homograft replacements 3 and 12 months after the initial repair for mycotic infe ction in 1 case and valvular stenosis in the other. The mean follow-up of the other 20 patients was 23 months: 14 were in NYHA functional Cl ass I, 4 are on the waiting list for replacement of their homograft fo r obstruction after an average period of 47 months. The authors strate gy is to perform surgical correction of truncus arteriosus very early: immediately in the neonatal period in cases with uncontrollable cardi ac failure, at 6 months at the latest. Small homografts make this aggr essive attitude feasable, but with an operative mortality in the first 6 months of life of 10.5% (2/19). The short and medium-term results a re encouraging: low mortality and early reoperation rates, satisfactor y clinical outcomes, replacement of dysfunctioning homografts 4 years after the initial implantation.