Aortic allografts and pulmonary autografts for replacement of the aortic valve and aortic root

Background. Extensive experience has accumulated with the use of aortic and pulmonary autografts for replacement of the aortic valve and the aortic ro ot. Three general techniques for insertion have been used: subcoronary (fre e-hand) valve implantation, mini- or inclusion-root implantation, and aorti c root replacement. Thirty-day mortality for elective operations with all o f these techniques has not exceeded 5%. Thromboembolic episodes have been r are, and endocarditis has occurred infrequently. Early hemodynamic performa nce has been excellent, without significant gradients or valve regurgitatio n in the majority of patients. Methods and Results. Progressive aortic regurgitation has been observed wit h continued follow-up, and is the most important complication of both types of valves. Leaflet failure and technical problems are the major causes of reoperation for patients receiving aortic allografts. There is some evidenc e to suggest that the prevalence of these complications is lower with the r oot replacement technique than with the intraaortic implantation methods. Conclusions. Reoperation for regurgitation of the neoaortic valve is the ma jor complication of the pulmonary autograft procedure. The incidence of reo peration appears to be lowest with the root replacement technique. Certain conditions (acute rheumatic fever, juvenile rheumatoid arthritis, systemic lupus, ankylosing spondylitis, Libman-Sachs endocarditis, and possibly a di lated aortic root) may be contraindications to the use of a pulmonary autog raft. Reoperation on the pulmonary allograft that is used to replace the au tograft may be necessary in up to 20% of patients at 20 years. (C) 1999 by The Society of Thoracic Surgeons.