AORTIC-VALVE REPLACEMENT WITH ALLOGRAFT AUTOGRAFT - SUBCORONARY VERSUS INTRALUMINAL CYLINDER OR ROOT

From April 1990 to May 1994, 89 patients (median age, 42 years; range, 10 days to 66 years) underwent aortic valve or root replacement with allografts or autografts. Thirteen patients were less than 18 years ol d at the time of operation. Indication for aortic valve replacement wa s aortic stenosis (50 patients, 56%), small stenotic prosthesis (2 pat ients, 2%), aortic valve endocarditis (19 patients, 21%), isolated aor tic regurgitation (17 patients, 19%), and type II truncus arteriosus ( 1 patient, 1%). The subcoronary implantation was used in 45 patients ( group A), and implantation of an intraluminal cylinder (16 patients) o r complete root replacement (28 patients) was performed in the remaini ng 44 patients (group B). The Ross procedure was performed in 22 patie nts. Intraoperative transesophageal echocardiography was used routinel y. Five patients died in the early postoperative period (6%), 2 in gro up A and 3 in group B. Three other patients required immediate replace ment of a failing graft by a mechanical prosthesis (1 in group A and 2 in group B). There has been no fate death. All survivors remained in New York Heart Association functional class I and were free of thrombo embolic complications. Endocarditis occurred in 2 patients, 1 year aft er operation. Both were successfully treated medically. Echocardiograp hic studies were obtained serially in every patient. Four patients, 2 in group A and 2 in group B underwent reoperation because of mild-to-m oderate aortic regurgitation (rate of reoperation, 5%). Two valves wer e repaired and two were replaced by an allograft. At late echocardiogr aphic follow-up (up to 4 years postoperatively), 22 of 42 patients in group A and 6 of 39 patients in group B showed some degree of aortic r egurgitation by color Doppler (p < 0.001). The mean postoperative tran svalvular gradient was 12 mm Hg in group A and 6 mm Hg in group B (p < 0.001). It is concluded that aortic valve replacement with either an allograft or an autograft can be performed in both children and adults with a low morbidity and mortality, yielding excellent hemodynamic re sults. It is suggested that the implantation of an intraluminal cylind er and the complete root replacement might be superior to the subcoron ary technique as they result inlower transvalvular gradients and less valvular regurgitation.