Aortic root replacement with a pulmonary autograft

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Abstract
A series of 42 consecutive patients with exclusively aortic rootreplacement using the pulmonary autograft is presented. The mean age atoperation was 19.3 years (range 0.3-41.4). Two patients died in hospital(4.8%; 70% CL: 0.0-8.2). This mortality was not related to the autograftprocedure. The mean follow-up time was 30 months (range 3-70; SD: 20). Latemortality consisted of two patients; in one of these severe autograftfailure occurred due to chronic juvenile rheumatoid arthritis. Theestimated survival rate at 4 years was 88.8% (70% CL: 83.3-94.5). Morbidityinvolved three patients. One had a total heart block after operation,requiring pacemaker implantation and two patients were reoperated: one forsevere autograft failure due to recurrent acute rheumatic fever and theother for severe stenosis at the distal anastomosis of the pulmonaryallograft. Thromboembolic complications and endocarditis were notregistered. Reoperations for technical or degenerative reasons were notnecessary. The estimated event-free survival rate at 4 years was 78.7% (70%CL: 71.0-86.4). Serial echocardiography (n = 28) showed a significantincrease of the autograft annulus diameter of 2.9 mm (SD: 2.7). Thirty-fiveof the 37 patients with an autograft in situ were in NYHA class I, and 2 inclass II. At last follow-up precordial color Doppler echocardiographyshowed moderate aortic regurgitation in one patient and no, trivial or mildaortic regurgitation in 36 patients. Stenosis of the autograft was notobserved. These medium-term results are promising with respect tomortality, morbidity and functional results.(ABSTRACT TRUNCATED AT 250WORDS)

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