Extended aortic root replacement with cryopreserved allografts: do they hold up?

The extended aortic root replacement technique is used for the surgical repair of left ventricular outflow tract obstruction complicated by concurrent hypoplastic aortic annulus, multiple levels of obstruction, or aortic insufficiency. Extended aortic root replacement incorporates the concepts of aortic root replacement and aortoventriculoplasty to create a comparatively simple procedure. Unique features of the technique include the implantation of an allograft, which makes the need for anticoagulation obsolete, and use of the donor mitral leaflet to enlarge the outflow tract. Since 1985, 32 patients in Denver have undergone placement of a cryopreserved aortic valve allograft as part of extended aortic root replacement. There were four hospital deaths (13%), and 1 child underwent cardiac transplantation 30 hours after operation. In 6 months to 4.8 years of follow-up, a 14-year-old boy with familial hyperlipidemia required coronary artery bypass grafting, and 3 children experienced allograft calcification with progressive insufficiency, which prompted allograft replacement. The other 23 patients are clinically well.