MEDIUM-TERM FOLLOW-UP OF PULMONARY AUTOGRAFT REPLACEMENT OF AORTIC VALVES IN CHILDREN

Pulmonary autograft replacement (PAG) of the aortic valve in children has been shown to be safe and effective with a low incidence of late valve dysfunction. Relief of all types of left ventricular outflow tract obstruction using the pulmonary root has been possible. Concern about the durability of the pulmonary root in the aortic position, and the potential for growth of the pulmonary autograft used either as a root replacement or intraaortic implant, has been questioned. Sixty-five consecutive patients, aged 1.8 to 21 years (mean 12 years) operated on between September 1986 and January 1993, 35 with an intra-aortic implant (IA) and 30 with root replacement (RR), were evaluated by clinical and serial echocardiographic studies (ECHO) up to 6.5 years postoperatively. The hospital mortality rate was 3.0 % (70 % CL 2.1 - 5.1 %). Two patients required reoperation for PAG insufficiency (AI), one for technical malalignment necessitating replacement at 6 months, and one with progressive leaflet prolapse due to adherence 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-related complications including reoperation was 92+/-5% at 6 years. Significant enlargement of the aortic annulus which parallels somatic growth has been measured by ECHO in 17 IA implants (P<0.001) and 17 RR patients (P<0.001) by 1 year, and in 10 IA (P=0.007) and 6 RR (P<0.05) by 2 years. Low risk (mortality 3%), absence of residual or recurrent obstruction, low incidence of recurrent progressive AI, and demonstrated enlargement of the pulmonary autograft appropriate for somatic growth, as well as the absence of dilatation of the autograft root replacement at 6.5 years suggest that the PAG is the ideal replacement for children requiring aortic valve replacement.