Heart, Lung and Circulation 2000; 9 15th Annual Inter ASC-ASCTS Meeting A187 FREESTYLE VALVES IN CHILDREN N Kang, GR Nunn, IA Nicholson, RB Chard New Children’s Hospital, Westmead, NSW, Australia INTRODUCTION: In children who require valve replacement or valved conduits, homografts have traditionally been used. How- ever their durability is limited by early calcification and structural dysfunction. We have been using Freestyle bioprostheses more recently in the hope of overcoming some of these limitations. The aim of this study was to review the performance of this prosthesis in children and examine the rate of calcification in these valves. METHODS: Prospectively collected data for all patients aged less than 18 years having Freestyle bioprostheses implanted were reviewed. Clinical and echocardiographic data were analysed. Limited CT scans are being performed to quantify the degree of valvular calcification. RESULTS: Sixteen bioprostheses were implanted. Seven were used as RV to PA conduits. There were four subcoronary aortic valve replacements, three aortic root replacements and two pulmonary valve replacements. Median age at implant was 8.0 years (range 13 days to 16 years). Median implant size was 23 mm (range 12-25 mm). One neonate with truncus arteriosus died peri- operatively due to pulmonary hypertension. One 14 mm valved conduit was explanted 2.2 years post-operatively when the child outgrew the prosthesis. Histology revealed no evidence of struc- tural valve degeneration or leaflet mineralisation. Echocardiograms performed at a mean of 5 months post-operatively demonstrated no significant prosthetic regurgitation and all valve gradients were less than 20 mmHg. There was no incidence of thromboembolism or prosthetic valve endocarditis. CONCLUSIONS: The Freestyle valve has proved to be a versatile bioprosthesis in children for a variety of indications. l’ost- operative haemodynamic performance and freedom from valve- related complications has been excellent. The results of CT scan quantified valve calcification rates are awaited. ALLOGRAFT PATCH AORTOPLASTY FOR COARCTATION REPAIR IN NEONATES AND INFANTS Jason Lambley, Homayoun Jalali, Peter Pohlner, Byalal Jagannath The Prince Charles Hospital, Brisbane Australia OBJECTIVE: The aim of this study was to study early and mid- term outcome of allograft patches for coarctation repair in neonates and infants, and to compare intraoperative and postoperative results with other widely used methods. METHODS: From January 1996 until December 1999, 106 patients were operated on for coarctation repair. Pulmonary artery allograft patch aortoplasty was used in 33 children (age 1 day - 16 months, mean 2.5 months). In 31 cases a primary procedure was performed. A further two were done following attempted resection and end to end anastomosis (n = 1) or subclavian flap repair (n = 1). Twenty-nine coarcts were of the juxtaductal type with four hav- ing additional arch hypoplasia. Twelve were isolated, 11 had other simple congenital defects and a further 10 had complex congenital heart disease. Follow up ranged from 1 to 43 months (mean 15 months). RESULTS: There were no operative mortality or paraplegia. There were three balloon angioplasties and two reoperations for recurrent coarctation. All other children remain free from further recurrence with echocardiograms excluding peak gradients in excess of 20 mm of Hg. CONCLUSIONS: Early to mid-term results suggest that allo- graft patch aortoplasty is comparable to other surgical treatment modalities. Its flexibility and versatility of use may be advanta- geous in repair of coarctation and/or arch repair in neonates and infants. Long-term data for use of allografts in this setting is not available yet but one may anticipate that it has the potential to rival its performances in other positions. INTERRUPTED AORTIC ARCH: ONE-STAGE OR TWO- STAGE REPAIR? N Kang, RB Chard, GR Nunn New Children’s Hospital, Westmead, New South Wales, Australia INTRODUCTION: Interrupted aortic arch is a complex congenital heart defect which is uniformly fatal if left untreated. Surgical treat- ment has evolved from a two-stage repair to a one-stage correction. Controversy exists regarding the optimal management strategy. METHODS: We undertook a 20 year review of our experience with treating interrupted aortic arch. RESULTS: Forty-seven patients were operated for interrupted arch. There were 15 type A, 30 type B and two type C interruptions. Five patients underwent single-stage repair under circulatory arrest with a 40% mortality. Forty-two patients had staged repair with synthetic conduit and pulmonary artery banding at first operation followed by VSD patching and debanding of the pulmonary artery. There was a 7% mortality at the first stage and 0% mortality at the second stage. Ten patients had further surgery for replacement of conduit (n = 6) or resection of left ventricular outflow tract obstruction (n = 4). CONCLUSIONS: We believe that staged repair is a safer option for treatment of interrupted arch. Single-stage correction may be reserved for type A interruptions with aortopulmonary window. However a significant proportion of patients with staged repair will require further surgery for conduit change and associated prob- lems. SURGICAL OPTIONS FOR TREATMENT OF HEART FAILURE Kimble Jett AORTIC VALVE REPLACEMENT IN PATIENTS WITH PRIOR CABG SURGERY PW Grant, D Law, HD Wolfenden, DC Newman Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Randwick Sydney, New South Wales, Australia INTRODUCTION: Aortic valve replacement (AVR) for aortic stenosis (AS) at the same time as coronary artery bypass graft (CABG) carries a relative low risk. This study was designed to assess he results of AVR for AS in patients with previous CABG. METHOD: Prospective 4 year review (June 1996 to June 2000) of 26 consecutive patients with previous CABG undergoing AVR and 163 patients undergoing primary combined AVRJCABG. The indication for AVR in all these patients was AS. Clinical, echocardio- graphic, cardiac catherisation and operative details were analysed. RESULTS: Of the 26 patients with previous CABG having AVR there were 15 isolated AVR and 11 AVRJCABG. The primary indica- tion for re-operation was aortic stenosis in 24 and coronary artery disease in two. Heterografts were implanted in 22 and mechanical in four. A patent LIMA to LAD graft was present in 12/26. Opera-