Medium-term follow-up of pulmonary autograft replacement of aortic valves in children

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Abstract
Pulmonary autograft replacement (PAG) of the aortic valve in childrenhas been shown to be safe and effective with a low incidence of late valvedysfunction. Relief of all types of left ventricular outflow tractobstruction using the pulmonary root has been possible. Concern about thedurability of the pulmonary root in the aortic position, and the potentialfor growth of the pulmonary autograft used either as a root replacement orintraaortic implant, has been questioned. Sixty- five consecutive patients,aged 1.8 to 21 years (mean 12 years) operated on between September 1986 andJanuary 1993, 35 with an intra- aortic implant (IA) and 30 with rootreplacement (RR), were evaluated by clinical and serial echocardiographicstudies (ECHO) up to 6.5 years post-operatively. The hospital mortalityrate was 3.0% (70% CL 2.1- 5.1%). Two patients required reoperation for PAGinsufficiency (AI), one for technical malalignment necessitatingreplacement at 6 months, and one with progressive leaflet prolapse due toadherence of the valve leaflet to a ventricular septal defect (VSD) patch.Freedom from significant aortic regurgitation at 6-year follow-up was 100%for RR and 91 +/- 6% for IA, and freedom from all valve-relatedcomplications including reoperation was 92 +/- 5% at 6 years. Significantenlargement of the aortic annulus which parallels somatic growth has beenmeasured by ECHO in 17 IA implants (P < 0.001) and 17 RR patients (P< 0.01) by 1 year, and in 10 IA (P = 0.007) and 6 RR (P < 0.05) by 2years.(ABSTRACT TRUNCATED AT 250 WORDS)

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