AORTIC ROOT REPLACEMENT WITH A PULMONARY AUTOGRAFT

A series of 42 consecutive patients with exclusively aortic root replacement using the pulmonary autograft is presented, The mean age at operation 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 autograft procedure, The mean follow-up time was 30 months (range 3-70; SD: 20), Late mortality consisted of two patients; in one of these severe autograft failure occurred due to chronic juvenile rheumatoid arthritis. The estimated survival rate at 4 years was 88.8% (70% CL: 83.3-94.5), Morbidity involved three patients, One had a total heart block after operation, requiring pacemaker implantation and two patients were reoperated: one for severe autograft failure due to recurrent acute rheumatic fever and the other for severe stenosis at the distal anastomosis of the pulmonary allograft. Thromboembolic complications and endocarditis were not registered. Reoperations for technical or degenerative reasons were not necessary, The estimated event-free survival rate at 4 years was 78.7% (70% CL: 71.0-86.4), Serial echocardiography (n = 28) showed a significant increase of the autograft annulus diameter of 2.9 mm (SD: 2.7), Thirty-five of the 37 patients with an autograft in situ were in NYHA class I, and 2 in class II, At last follow-up precordial color Doppler echocardiography showed moderate aortic regurgitation in one patient and no, trivial or mild aortic regurgitation in 36 patients, Stenosis of the autograft was not observed, These medium-term results are promising with respect to mortality, morbidity and functional results. The autograft procedure may be contraindicated in patients with chronic juvenile rheumatoid arthritis and relatively contraindicated in patients with a history of acute rheumatic fever, Extended follow-up is warranted to observe progression of autograft annular dilatation and its clinical consequences.