"Fresh", antibiotic sterilized aortic homografts in extracardiac valved conduits. Long-term results.

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.