CLINICAL OUTCOME AND LEFT-VENTRICULAR FUNCTION AFTER PULMONARY AUTOGRAFT IMPLANTATION IN CHILDREN

Background. Aortic root replacement with a pulmonary autograft is an a lternative treatment for children with aortic valve or root disease, o r both. Methods. Twenty-six patients (18 boys and 8 girls) with a mean age of 10.9 years (range, 0.3 to 16.9 years) underwent this procedure s in a 7-year period. The mean follow-up period was 3.2 years (range, 0.2 to 7.5 years). Results. During follow-up 3 patients died and one a utograft was replaced with a mechanical valve. The actuarial survival and actuarial event-free survival rates were 87% and 79%, respectively , at both 5 and 7 years. None of the surviving patients had complaints , and all have done well and are living normal lives. Electrocardiogra phic signs of myocardial ischemia and left ventricular hypertrophy wer e not present. Echocardiography showed autograft valve regurgitation t o be absent or trivial (n = 17) or mild (n = 5). Stenosis was not pres ent. Increasing autograft annulus diameters were noted during follow-u p, but this was not related to the severity of autograft regurgitation . Left ventricular dimensions and function were within normal limits l ater than 1 year after the operation. Only 2 patients had a moderate p ulmonary stenosis without right ventricular hypertrophy. Conclusions. The surgical results, clinical outcome, valve function, and left ventr icular function in our patients have been good. This procedure is reco mmended as a method of aortic valve replacement in children. (C) 1997 by The Society of Thoracic Surgeons.