PULMONARY AUTOGRAFT FOR AORTIC-VALVE REPLACEMENT IN RHEUMATIC DISEASE- A CAVEAT

Pulmonary autograft replacement of the aortic valve offers an attracti ve option in the younger patient with growth potential and long-term s urvival. In our institution between January 1990 and August 1994, 78 p atients have undergone this procedure. The mean age was 18.6 +/- 7.36 years (range, 1 to 41 years). The etiology was rheumatic in 63 patient s (80.7%). Aortic regurgitation was the predominant lesion in 60 patie nts (76.9%). Significant mitral regurgitation requiring operation was present in 22 patients (28.2%). All patients underwent pulmonary autog raft replacement of the diseased aortic valve and the mitral valve was repaired in 22 patients. There were no hospital mortality, endocardit is, or thromboembolism in the series up to date. There have been two l ate non-cardiac deaths. Five patients (6.4%) required reoperation, one for mitral repair failure and four for autograft failure. Acute rheum atic valvulitis was demonstrated in one of the reoperated patients. Ec hocardiography of 68 patients followed up more than 2 months show prog ression of aortic regurgitation more than 2/4+ in 12 patients (15.4%). Four of these patients have been reoperated without mortality. In con clusion, although the Ross procedure remains a safe and attractive alt ernative in aortic valve operation, the progression of aortic regurgit ation, especially in the younger patient with rheumatic etiology, rema ins a concern.