Each DAH candidate underwent thorough outpatient evaluation of the indication for AVR followed by detailed discussion with the patient and/or parents regarding conventional AVR options and this new therapeutic alternative. Once the patient/parents consented for implantation of a DAH, search for a suitable homograft started. Patients were informed when an appropriate homograft was available for processing and after microbiological testing of the DAH was negative, they were admitted to the hospital shortly before operation.