Homograft replacement of aortic root with reimplantation of coronary arteries. Results after one to five years.

Between 1976 and 1980, 26 patients aged 7 to 36 years had complete replacement of the aortic root with a valved homograft into which the coronary arteries were reimplanted. The main indication was the tunnel type of obstruction combining a hypoplastic valve ring, often with supra and subvalvar stenosis. Nineteen had previous operations for congenital left ventricular outflow obstructions. There was one perioperative death and one late death from progressive pulmonary vascular disease. Relief of left ventricular outflow tract obstruction was achieved in a majority of cases and the valves were entirely competent. With increasing experience, the initial problems of malalignment and torsion of the coronary arteries and complete heart block have been largely overcome. This operation provides an alternative technique for the management of diffuse left ventricular outflow tract obstruction and related problems in young patients. The long-term results of aortic homografts are well documented, and by eliminating the problems of aortic regurgitation it is anticipated that this may represent an advance in treatment.