AORTIC ROOT REPLACEMENT - 20 YEARS EXPERIENCE OF THE USE OF HOMOGRAFTS

The aortic root was replaced with a free root homograft 100 times in 91 patients from 1970 to January 1987. The ages of the patients were in the range 5-73 years (mean 29.7). There were 63 males and 34 females. Thirty had endocarditis with root abscesses. Forty-one had congenitally small aortic roots and 20 patients had such severe root calcification that root replacement was required. One patient had an aortic sinus aneurysm repaired using this technique. Operative mortality (overall 24%) analysed by operative indication was highest for prosthetic endocarditis (33%). 20% of those with root calcification and 15% of those operated on for hypoplastic roots died. Endocarditis was cured in 19 of 20 survivors. One patient needed repeat root replacement to achieve this. Thirteen patients out of 35 survivors in the hypoplastic group were restudied. Mean subvalvular gradient was 12 +/- 9 mmHg (range 0-27 mmHg). Late mortality was lowest in the endocarditis group (5%), and 11% in the hypoplastic group. There were 4 (24%) late deaths in the root calcification group but 2 were non cardiac. Eight homograft roots failed, two in the endocarditis group and one in the hypoplastic group due to endocarditis. The remainder failed because of 'wear and tear'. Five were replaced using homografts and one by a composite graft. Two were treated by prosthetic subcoronary aortic valve replacement with pericardial patch enlargement of the root. A further patient with Marfan's syndrome had an infected composite graft. This was replaced by a homograft root. There are 5 long term survivors of 7 repeat aortic root replacements. Indications for the various operations and technical aspects are described. Eighty-five percent follow-up is reported from 0 to 12 years with late morbidity.