Pulmonary autografts in patients with aortic annulus dysplasia

Background. Pulmonary autograft replacement of the aortic valve is indicated in the young, in patients with an active life style, and when anticoagulation is contraindicated. Its use in patients with a dilated aortic annulus or sinotubular junction has historically had a less satisfactory result. Methods. To extend the advantages of the pulmonary autograft to this group of patients, we performed the Ross operation as a root replacement and ''fixed'' and narrowed the aortic annulus with external woven Dacron in 12 patients, Teflon felt in 5, and pericardium in 3. Twenty patients, aged 7 to 47 years (median, 27 years), are reported to assess the effectiveness of this operative technique. Preoperative aortic annulus diameter was 23 to 33 mm (13 were >27 mm). Results. There were no operative or late deaths. Early postoperative, echocardiographic evaluation of autograft valve function revealed no significant obstruction, grade 0 aortic sufficiency in 5, trace to 1+ in 12, and 2+ in 2. Late evaluation of 1 to 4 years is available in 12 patients and has shown no increase in autograft insufficiency. Conclusions. This experience suggests that operative fixation of the aortic annulus with an external Dacron cuff is effective and is recommended in patients with an aortic annulus that is significantly greater than normal for their body size.