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Updated: Aug 9, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
"Fresh", antibiotic sterilized aortic homografts in extracardiac valved conduits. Long-term results
Insights
Fresh antibiotic-sterilized aortic homografts used as valved external conduits in 65 children demonstrated good performance and rare leaflet degeneration. This surgical approach offers effective conduit solutions for complex pediatric cardiac conditions.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials in Medicine
Background:
- Valved external conduits are crucial for complex congenital heart defects.
- Antibiotic-sterilized aortic homografts offer a potential solution for pediatric cardiac reconstruction.
- Previous palliative surgeries were common in the studied pediatric population.
Purpose of the Study:
- To evaluate the efficacy and long-term performance of fresh antibiotic-sterilized aortic homografts as valved external conduits in pediatric patients.
- To assess the operative mortality, morbidity, and functional outcomes associated with this surgical technique.
Main Methods:
- Retrospective analysis of 65 pediatric patients (aged 2 weeks to 15 years) who received aortic homograft conduits between 1971 and 1980.
- Surgical procedures utilized cardiopulmonary bypass, hypothermia, and cardioplegia; deep hypothermia with circulatory arrest was used in select infants.
- Postoperative assessment included recatheterization in 21 patients to evaluate conduit performance.
Main Results:
- Thirty-eight percent (25/65) of patients died postoperatively, with mortality linked to lesion complexity, patient condition, and pulmonary vascular disease.
- Seven late deaths occurred.
- Of 21 restudied patients, 18 (86%) showed satisfactory conduit performance without significant gradients or regurgitation.
- Chest X-rays revealed homograft aortic wall calcification in 56% of patients; aortic valve calcification was rare (1 child).
Conclusions:
- Fresh antibiotic-sterilized aortic homografts serve as effective valved external conduits in pediatric cardiac surgery.
- The technique is associated with good functional outcomes and rare leaflet degeneration.
- Ease of insertion and improved hemostasis are noted advantages.
Abstract:
Between 1971 and 1980, 65 children, aged 2 weeks to 15 years (mean 6.8 years) had "fresh" antibiotic sterilized aortic homografts inserted as a valved external conduit. Thirty-six patients (55%) had undergone previous palliations. Operations were performed on cardiopulmonary bypass, with hypothermia and cardioplegia. In selected young infants, deep hypothermia with circulatory arrest was used. Twenty-five patients (38%) died after the operation. Mortality was related to the complexity of the lesion, the condition of the child on admission, and the degree of pulmonary vascular disease. In addition, there were 7 late deaths. Twenty-one patients were recatheterized, either as a part of routine postoperative assessment (13) or because of symptoms (8). Satisfactory conduit performance, judged by the absence of significant gradients or regurgitation, was found in 18 out of 21 restudied patients. Calcification of the homograft aortic wall was seen on chest X-ray in 56% of patients. The aortic valve calcified in only one child, following an episode of subacute bacterial endocarditis. We conclude that fresh antibiotic preserved aortic homografts perform well in extracardiac valved conduits. They are easy to insert and better hemostasis can be achieved. Degeneration of the valved leaflets is extremely rare.
