EXTENDED AORTIC ROOT REPLACEMENT WITH PULMONARY AUTOGRAFTS - EXPERIENCE IN 14 CASES

The surgical relief of complex multilevel left ventricular outflow tra ct obstruction remains a challenging problem. We present a new operati on that combines the concepts of aortoventriculoplasty, extended aorti c root replacement, and the use of a pulmonary autograft. Fourteen pat ients underwent this operation: 9 patients after previous attempts to relieve diffuse subvavalvular stenosis and 5 patients who had excessiv e gradients over an outgrown aortic valve prosthesis. All patients exc ept 1 survived the operation. Complete heart block developed in 1 pati ent after a septal infarction. One patient remained in congestive hear t failure and died suddenly after 17 months. All other patients are in New York Heart Association class I after a mean follow-up of 20 +/- 1 2 months. All patients showed excellent function of the autograft and homograft valve at follow-up. This operation might present a more dura ble or even a definitive solution in the management of these complex l eft ventricular outflow tract obstructions.