AORTIC ROOT REPLACEMENT WITH A PULMONARY AUTOGRAFT

A series of 42 consecutive patients with exclusively aortic root repla cement using the pulmonary autograft is presented, The mean age at ope ration was 19.3 years (range 0.3-41.4). Two patients died in hospital (4.8%; 70% CL: 0.0-8.2), This mortality was not related to the autogra ft procedure, The mean follow-up time was 30 months (range 3-70; SD: 2 0), Late mortality consisted of two patients; in one of these severe a utograft failure occurred due to chronic juvenile rheumatoid arthritis . The estimated survival rate at 4 years was 88.8% (70% CL: 83.3-94.5) , Morbidity involved three patients, One had a total heart block after operation, requiring pacemaker implantation and two patients were reo perated: one for severe autograft failure due to recurrent acute rheum atic fever and the other for severe stenosis at the distal anastomosis of the pulmonary allograft. Thromboembolic complications and endocard itis were not registered. Reoperations for technical or degenerative r easons were not necessary, The estimated event-free survival rate at 4 years was 78.7% (70% CL: 71.0-86.4), Serial echocardiography (n = 28) showed a significant increase of the autograft annulus diameter of 2. 9 mm (SD: 2.7), Thirty-five of the 37 patients with an autograft in si tu were in NYHA class I, and 2 in class II, At last follow-up precordi al color Doppler echocardiography showed moderate aortic regurgitation in one patient and no, trivial or mild aortic regurgitation in 36 pat ients, Stenosis of the autograft was not observed, These medium-term r esults are promising with respect to mortality, morbidity and function al results. The autograft procedure may be contraindicated in patients with chronic juvenile rheumatoid arthritis and relatively contraindic ated in patients with a history of acute rheumatic fever, Extended fol low-up is warranted to observe progression of autograft annular dilata tion and its clinical consequences.