Surgical options and results of repeated aortic root replacement for failed aortic allografts placed in childhood

A, Extended aortic root replacement begins with excision of aortic root and preparation of coronary buttons. B, Oblique incision is made in right ventricle just below pulmonary valve, and this incision is joined by incision through aortic valve anulus into interventricular septum. C, Aortic root is replaced with aortic allograft with attached allograft anterior mitral leaflet used to close interventricular septum. D, Right ventricular incision is closed with separate patch to prevent obstruction. Adapted with permission from Mitchell MB, Campbell DN, Bishop DA, Clarke DR. Aortic allografts for left ventricular outflow tract replacement in children. In: Williams WG, editor. Pediatric cardiac surgery annual of the seminars in thoracic and cardiovascular surgery, vol 3. Philadelphia: WB Saunders; 2000. p. 156, 157, 158, 159.

Thoracic computed tomographic scan 12 years after previous extended aortic root replacement with cryopreserved aortic allograft. There is severe allograft calcification. Note proximity of densely calcified RVOT patch to posterior table of sternum.

Kaplan-Meier estimated freedom from all valve-related death or event for 25 repeated aortic root replacements performed on 23 patients. Vertical lines indicate censored data.

Kaplan-Meier estimated freedom from all valve-related death or event for reoperations with aortic allografts (group AA), pulmonary autografts (group PA), and mechanical valved conduits (group MV). There were no statistically significant differences among groups (log-rank test). Vertical lines indicate censored data.