Pulmonary autograft valve replacement in the dilated and asymmetric aortic root

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Abstract
Pulmonary autograft aortic valve replacement is the only technique forimplantation of a biologic, vital and thus nondegenerating valve. Thetechnique of root replacement overcomes problems of asymmetric aortic rootsand reduces the risk of malalignment, but bears the risk of dilatation. Wehave performed pulmonary autograft aortic root replacement in 20 patients(mean age 22 years, range 5-38). Twelve presented with aortic incompetence,3 with stenosis and 5 with combined defects. Initially roots were implantedjust supraannularly with two running suture lines. As the neo-aortic rootsgradually dilated, we started to implant autografts intraannulary, butstill one valve dilated and aortic incompetence (AI) increased from grade Ito II. Consequently the remaining aortic wall was wrapped around the newroot and the composite subsequently was reinforced by a circular absorbablemesh. In addition, the aorta and pulmonary valve were exactly sized and theaortic root was reduced by commissuroplasty stitches up to 6 mm in diameterin seven cases. The ventricular size decreased in all patients 10 daysafter surgery, the left ventricular end-diastolic diameters (LVEDD) from 58+/- 12 to 52 +/- 10 mm (P = 0.0002; paired t-test) and left ventricularend-systolic diameter (LVESD) from 41 +/- 12 to 36 +/- 10 mm (P = 0.008),but the contractility did not change significantly (fractional shorteningfrom 31 +/- 9% to 30 +/- 9%). The diameter of the new aortic ring increasedfor the supraannular position but size matching and the intraannular valveposition reduced the new ring size significantly (P = 0.001).(ABSTRACTTRUNCATED AT 250 WORDS)

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