Replacement of the aortic valve or root with a pulmonary autograft in children

• Published in: The Annals of thoracic surgery Vol. 51; no. 3; pp. 424 - 429
• Main Authors: Gerosa, Gino, McKay, Roxane, Ross, Donald N.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-1991; Elsevier Science
• Subjects: Adolescent; Aortic Valve - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Child; Child, Preschool; Diseases of the aorta; Endocarditis, Bacterial - etiology; Female; Follow-Up Studies; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Humans; Male; Medical sciences; Postoperative Complications; Pulmonary Valve - transplantation; Reoperation; Survival Rate; Human; Autograft; Treatment; Cardiac valvular disease; Follow up study; Surgery; Cardiovascular disease; Aortic valve disease; Child; Aortic valve; Pulmonary valve; Result
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/0003-4975(91)90858-N

Between January 1967 and December 1988, 34 patients ranging in age from 3 to 18 years (mean, 14 ± 3.6 years) underwent replacement of the aortic valve or root with their own pulmonary valve. The indication for operation was left ventricular outflow obstruction in 16 patients (47%), aortic regurgitation in 14 (41%), mixed aortic valve disease in 3 (9%), and failure of a previously implanted aortic homograft in 1 (3%). There were four early deaths, all before 1971, giving a hospital mortality of 11.8% (70% confidence interval, 6% to 20%). Surviving patients have been followed up a cumulative total of 214 patient-years, the longest period of observation being 16 years 8 months. Late mortality was 13.3% (70% confidence interval, 7% to 23%), and 4 other patients required removal of the pulmonary autograft for endocarditis. Actuarial rates at 16 years were 74% ± 11% for freedom from reoperation on the left ventricular outflow tract, 80% ± 10% for freedom from reoperation on the right ventricular outflow tract, and 77% ± 10% for late survival. There was no instance of primary structural degeneration in the pulmonary autograft, and all surviving patients were in New York Heart Association functional class I without medication. This experience demonstrates that the pulmonary autograft can achieve good early and medium-term results in young patients. Should growth potential be realized, it might constitute the ideal biological valve for the left ventricular outflow in children.