Truncus arteriosus (TA) represents 1% to 3% of congenital heart malformations and carries a high mortality if untreated of approximately 85% at 1 year, with almost half the deaths occurring during the first month of life. Significant truncal valve regurgitation (TVR) can be present in up to 50% of cases and reduces survival if persistent after surgical correction. Repair of truncal valves is a promising approach since growth potential and hemodynamics are maintained. Nevertheless this remains a technical challenge and as much as 50% of these valves still need to be replaced at the time of primary repair. Cryopreserved aortic homografts used as aortic root substitutes have provided preservation of excellent hemodynamic conditions as well as prevention of infectious and thromboembolic complications of prosthetic valves. Even if they present structural deterioration with time, they represent an attractive alternative to prosthetic valves in infants and children who would anyhow need reoperation because of the outgrowth of valvular or conduit substitutes.