Aortic pulmonary autograft implant: Medium-term follow-up with a note on anew right ventricular pulmonary artery conduit

Background: The Ross operation has been applied to various aortic valve pat hologies, particularly when somatic growth is an issue. However, associated cardiac disease and technical problems may limit its use with regard to as sociated procedures and issues of right ventricular outflow reconstruction. Materials and Methods: From December 1992 to March 1998, 24 patients under went aortic pulmonary autograft implantation, There were 14 males and 10 fe males, 15 +/- 10 years of age (mean a SD) (range 1 to 50 years):, weighing 42.8 +/- 20 kg (mean a SD) (range 8 to 78 kg). Aortic insufficiency was pre sent in 15 (62.5%) patients, stenosis in 8 (33.3%) patients, and valvar ste nosis associated with left ventricular outflow tract obstruction in 1 (4.1% ) patient. Etiology was rheumatic in 17 patients and congenital in 7. The R oss procedure was accompanied by a partial-Konno left ventricular outflow e nlargement in one patient, and mitral valve annuloplasty, mitral commissuro tomy, and tricuspid valve replacement in three other patients, respectively . The right ventricular outflow was reconstructed with a valved pulmonary h omograft in 14 patients and with a Shelhigh No-React(R) porcine pulmonary c onduit in 10 patients. Evaluation was done by New York Heart Association (N YHA) Class and by echocardiography at a follow-up of 22.8 +/- 24 months (me an a SD) (range 3 to 63 months). Results: There were no operative mortaliti es and no postoperative arrhythmias. One (4.1%) patient required intra-aort ic balloon pump (IABP) support for 3 days, one (4.1%) patient died 2 years later of probable arrhythmia, and one (4.1%) patient required mechanical ao rtic valve replacement 2 years later for severe autograft insufficiency. Le ft ventricular ejection fraction was unchanged (preoperative 62.4% +/- 30%, postoperative 64.2% +/- 30% [mean +/- SD], [p = NS]) and no significant gr adient was documented by echocardiographic Doppler in the right and left: v entricular outflow tracts. The aortic insufficiency scale decreased from a mean of 3.9 +/- 0.2 to a mean of 1 +/- 0 (p < 0.01). NYHA Class decreased t o I in all patients, from III (10) and II (14). Conclusions: The pulmonary autograft in the aortic position is suitable for aortic valve replacement i n pediatric and adult patients with good medium-term results and in patient s with rheumatic etiology, and it provides a desirable solution in the pres ence of associated pathologies, such as left ventricular tract obstruction or associated multivalvular disease. The development of new means of right ventricular outflow reconstruction must parallel the progress achieved for the left side.