# Cryopreserved Aortic Homograft Replacement in Pediatric Patients: A Single-Center Experience with Midterm Follow-Up

## TL;DR

This study shows that cryopreserved aortic homografts are safe and effective for pediatric aortic valve replacement in the short and medium term.

## Contribution

The study provides a single-center experience and midterm follow-up data on cryopreserved aortic homografts in pediatric patients.

## Key findings

- No 30-day mortality was observed, with only one late mortality at year 3.
- 92.9% of grafts maintained normal function at 5-year follow-up.
- Early hemodynamic performance was satisfactory with a mean gradient of 8.4 ± 3.2 mmHg.

## Abstract

Objective: To evaluate early and midterm outcomes of cryopreserved aortic homograft implantation in pediatric patients undergoing aortic valve and root replacement. Methods: A retrospective analysis was conducted on 36 pediatric patients aged 2 to 7 years who underwent cryopreserved aortic homograft implantation between January 2016 and December 2024. Indications included complex congenital aortic valve disease, annular hypoplasia, failed Ross procedure, and infective endocarditis. The standard root replacement technique was used under moderate hypothermic cardiopulmonary bypass. Postoperative outcomes were analyzed, including early complications, mortality, echocardiographic parameters, and long-term graft performance. Statistical analyses included the use of chi-square test, the Mann–Whitney U test, and Spearman correlation. Results: There was no 30-day mortality. One patient (2.8%) experienced late mortality at year 3, and two patients (5.6%) underwent reoperation at years 4 and 7 due to root aneurysm and severe regurgitation, respectively. Early postoperative echocardiography showed satisfactory hemodynamic performance with a mean gradient of 8.4 ± 3.2 mmHg. At 5-year follow-up, 92.9% of grafts maintained normal function. Conclusions: Cryopreserved homografts provide a safe and effective option for pediatric aortic valve replacement in the early and midterm period. However, potential late complications such as structural degeneration or root dilation necessitate long-term surveillance. Advances in decellularized grafts may improve future durability and integration.