F. Santini et al., Pulmonary autograft replacement of the bicuspid aortic valve: a successfulsurgical option for young adults, INT J CARD, 71(2), 1999, pp. 115-120
Citations number
29
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
A severely dysfunctioning congenitally bicuspid aortic valve may require su
rgical treatment within the fourth decade of life. Among conventional optio
ns, the pulmonary autograft (PA) offers many theoretical advantages particu
larly for young patients, including potential for growth, hemodynamic perfo
rmance. no need for anticoagulants and freedom from endocarditis. However t
he operation is more complex and longer, may interfere with coronary and ri
ght ventricular anatomy and function and may expose the patient to the down
side of two valves at risk. Aim of this retrospective study was to evaluate
the mid-term results achieved with the PA performed in adolescents and you
ng adults with a bicuspid aortic valve. Between July 94 and June 98, 26 pat
ients, 22 males and four females, with a mean age of 24+/-10 years (range,
11 to 38), underwent bicuspid aortic valve replacement with a pulmonary aut
ograft (stenosis 2-8%; insufficiency 13-50%; combined 11-42%). Eight patien
ts (31%) were in NYHA FC I, 17 (65%) in II, and 1 (4%) in III. Mean preoper
ative ejection fraction was 67+/-7%. Three patients (11.5%) had a past medi
cal history of endocarditis (healed in all) and in two the PA was a re-do p
rocedure. The PA was inserted as a subcoronary implant in one case (4%) and
utilized as a root in the remaining 25 (96%). The right ventricular outflo
w tract was reconstructed with a cryopreserved pulmonary homograft conduit
in all cases. Mean cardiopulmonary bypass and aortic crossclamp times were
204+/-50 min (range, 174 to 300) and 157+/-35 min (range, 133 to 193) respe
ctively, No early or late deaths had occurred at a mean follow-up of 22.5 m
onths (range, 5 to 47.5). The first patient in the series (4%) was reexplor
ed for bleeding and needed transfusions. The subsequent routine use medical
and surgical strategies resulted in no further need for postoperative reex
ploration.: and successful containment of total postoperative blood loss (<
350 ml/m2BSA). 2-D Echo evaluation of neo-aortic valve competence at 6 mont
hs, revealed no evidence of aortic valve regurgitation in 17 (65%), trivial
regurgitation in seven (27%), mild in one (4%)and mild-to-moderate in one
(4%). The latter patient (subcoronary implant PA) required reoperation. At
six months, the mean degree of regression of left ventricular mass compared
to pre-operative data, was 36% (333+/-94 to 212+/-60 gr, p<0.05). All pati
ents are asymptomatic, in NYHA FC I, and enjoy normal social interaction. I
n conclusion, PA root implantation can be offered as a low-risk alternative
to conventional prosthetic aortic valve replacement to adolescents and you
ng adults with a bicuspid aortic valve. The routine achievement of blood lo
ss containment has minimized the risk of transfusion thus contributing to e
xpand the indication in young patients. Continued patients evaluation parti
cularly with regard to evidence of neo-aortic valve degeneration, root dila
tation and homograft dysfunction in the long term is warranted. (C) 1999 El
sevier Science Ireland Ltd. All rights reserved.