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Eur J Cardiothorac Surg 2005;27:420-424
© 2005 Elsevier Science NL

Improved outcome with composite graft versus homograft root replacement for children with aortic root aneurysms

^a Department of Cardiovascular Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
^b Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
^c Department of Biostatistics, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
^d Department of Surgery, Oulu University Hospital, Oulu, Finland

Received 11 August 2004; received in revised form 8 December 2004; accepted 13 December 2004.

^* Corresponding author. Address: Children's National Medical Center, 111 Michigan Avenue, Washington, DC 20010, USA. Tel.: +1 202 884 2811; fax: +1 202 884 5572. (E-mail: rjonas{at}cnmc.org).

Objective: Review of surgical repair of aortic root aneurysms using composite graft or homograft in children. Methods: A consecutive series of 34 children (mean age 10.8±5.4 years) who underwent elective aortic root replacement using composite graft or homograft from 1987 to 2003 (mean follow-up 5.7±3.7 years). Results: Preoperatively, the aortic annulus and aortic root average z-scores were 4.1±2.2 and 9.4±4.7, respectively. Composite graft root replacement was performed in 22 patients, and cryopreserved aortic homograft root replacement in 12 patients. There was one perioperative death in the homograft group due to sudden cardiovascular collapse. There was one late death in the composite graft group due to acute aortic dissection, and two late deaths in the homograft root replacement group, one at 7 months postoperatively due to coronary artery thrombosis and one due to severe chronic myocardial dysfunction 5 years postoperatively. One patient who initially had a homograft died due to mechanical valve thrombosis following reoperative composite graft replacement. Five patients had reoperations at a median of 7.1 years after initial surgery. One patient in the composite graft group underwent arch replacement. There were no graft related reoperations after composite graft root replacement, but 4 patients in the homograft group had reoperative composite graft replacement. Predictors of reoperation included age at surgery, lower weight, and longer ICU time (P<0.05). Conclusions: In children with aortic root aneurysms, reoperation is more common after homograft root replacement than composite graft replacement. Composite graft root replacement provides more stable repair of the aortic root.

Key Words: Aortic root aneurysm • Composite graft • Homograft

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