Km. Dossche et al., Aortic root replacement with the pulmonary autograft: An invariably competent aortic valve?, ANN THORAC, 68(4), 1999, pp. 1302-1307
Citations number
18
Categorie Soggetti
Cardiovascular & Respiratory Systems","Medical Research Diagnosis & Treatment
Background. Pulmonary autograft aortic root replacement was used in adults.
Risk factors for aortic regurgitation (AR), and for pulmonary allograft va
lve stenosis are identified.
Methods. From February 1991 through April 1998, 80 adults (mean age 34.5 ye
ars) underwent pulmonary autograft aortic root replacement. Primary diagnos
is was AR in 43 (53.7%) patients, aortic stenosis in 13 (16.3%) and mixed d
isease in 24 (30%) patients. A root reinforcement ring was used in 32 (40%)
patients.
Results. There was no hospital mortality. Estimated patient survival is 100
% at 7 years. A total of 3 patients underwent reoperation: 2 on the autogra
ft for severe AR, 1 for pulmonary allograft stenosis. Freedom from reoperat
ion on the autograft is 96.7 +/- 2.4% at 7 years. Multivariate analysis ind
icated bicuspid aortic valve disease as an incremental risk factor for AR a
t discharge (p = 0.036, odds 3.5). Univariate analysis identified operation
for pure AR as risk factor far AR during follow-up (p = 0.041). Mild AR or
more increased from 2.5% at discharge to 11.3% during follow-up (p = 0.008
). Progression of AR was limited by the use of a reinforcement root ring (p
= 0.031). Freedom from mild AR or more in patients with and without a rein
forcement root ring was 100% and 72.9 +/- 9.3% respectively, at 5 years (p
= 0.119). Pulmonary allograft stenosis occurred in 15 (22.5%) patients. Mul
tivariate analysis revealed that large sized pulmonary allografts were less
prone to stenosis (p 0.048, odds 0.13).
Conclusions. Pulmonary autograft root replacement can be performed with few
complications. During follow-up, a significant increase in mild AR or more
is observed. The use of a reinforcement root ring is effective in preventi
ng progression of AR. (C) 1999 by The Society of Thoracic Surgeons.