Midterm to Long-term Outcomes After Aortic Valve Replacement With Homograft in Children

Background: Aortic homograft root replacement is an alternative to mechanical aortic valve replacement or a Ross operation for children with aortic valve disease. This study aimed to evaluate the long-term outcomes of aortic homograft root replacement. Methods: Between 2004 and 2021, 38 children underwent replacement of their aortic valves with an aortic homograft at a single institution. Electronic medical records were reviewed. Survival and reinterventions were the 2 main end points of interest. Results: The median age and weight were 14 years (interquartile range [IQR], 7-17 years) and 52 kg (IQR, 26-75 kg). Six patients were syndromic (6/38 [16%]), and 4 patients had active endocarditis (4/38 [13%]). Median aortic homograft size implanted was 23 mm in diameter (IQR, 21-24 mm). There was no early mortality and 2 late deaths (5.3%); 8 homografts (21%) were replaced at follow-up with no deaths after replacement of the homograft. Of the 38 implanted homografts, 28 (74%) were functioning well at a median of 81 months after initial implantation. The actuarial reintervention-free survival was 50% at 224 months. The Kaplan-Meier estimated survival at 220 months was 90%. Conclusions: Replacement of the aortic valve with an aortic homograft is a reasonable valve substitute in children, recognizing that some of these homografts will need to be replaced over time. The risk of reoperation is low, and it can be performed safely.