Extended aortic root replacement with,aortic allografts or pulmonary autografts in children

Objectives: To evaluate the early results and effectiveness of left ventric ular outflow tract enlargement with aortic allograft or pulmonary autograft in children with complex left ventricular outflow tract obstruction. Metho d: The records of 30 children who underwent aortic root enlargement and rep lacement with either an aortic allograft (22 patients) or pulmonary autogra ft (8 patients) between January 1987 and June 1997 were reviewed.: The pred ominant diagnosis was complex left ventricular outflow tract obstruction (n = 19), associated with aortic incompetence in 11 children, Before root enl argement, 27 children underwent surgical valvotomy (14 patients), balloon d ilatation (10 patients), or both interventions (3 patients). Mean age at ro ot enlargement was 5.4 +/- 3.5 years (range, 2 days-16 years). Most of the children (27 patients) underwent a Konno aortoventriculoplasty; Concomitant septal myectomy was performed in 4 children, mitral valve procedure in 5 c hildren, and endocardial fibroelastosis resection in 1 child, Results: Five children (17%) died in hospital, Four of these were infants less than 2 mo nths old. All had acute aortic incompetence as the result of recent interve ntion necessitating urgent operation. The fifth child, aged 10 years, died of myocardial failure 2 weeks after the operation. During the follow-up per iod (mean length, 4.1 +/- 2.8 years), sudden death occurred in 1 child 3 mo nths after tbe operation. Follow-up echocardiograms (obtained for 23 of the surviving 24 children within 3 +/- 2.3 years) showed a left ventricular ou tflow tract gradient reduced from a mean of 65 to 11 mm Hg (P = .001); Z va lue increased from a mean of -0.5 to 4.1 (P < .001), and aortic incompetenc e was trivial or mild except in 2 children. Conclusion: Urgent aortic root enlargement in decompensating neonates carries higher mortality rates. In o lder children, the early results of root enlargement and implantation of al lograft or autograft are good.