THE INFLUENCE OF GEOMETRIC MISMATCH BETWEEN THE NATIVE AORTIC, NATIVEPULMONARY AND HOMOGRAFT PULMONARY VALVE ON THE RESULTS OF THE PULMONARY AUTOGRAFT OPERATION

Background: The pulmonary autograft operation has achieved broad accep tance and may be the ideal aortic valve substitute. Both the pulmonary autograft and the aortic homograft are more complicated procedures th an prosthetic valve replacement. The trend to insert the pulmonary aut ograft as a root replacement rather than in the subcoronary position h as achieved greater uniformity in the results, but there is still conf using diversity in opinions on technical details and anatomical dimens ions. The importance of both size and shape mismatches between the thr ee valves involved has received little attention. The valves often dif fer in diameter and in the shape of the recipient aortic annulus. This uncertainty and the diversity of opinions on essential technical deta ils was disconcerting when we proceeded from aortic homograft-to-pulmo nary autograft operations, this was compounded by only a single homogr aft being available for every operation as we have no homograft bank. Methods: We compared the hemodynamic results regarding various geometr ic mismatches. All operative details were the same and patients were s tudied at regular intervals. Comparisons were made in patients with mi smatch between recipient aortic annulus and pulmonary autograft. Patie nts with a normal tricuspid aortic annulus were compared to those with either a circular redo prosthetic valve annulus or a bicuspid recipie nt annulus. Thirdly we compared the patients with plication of the aor tic annulus to those with remodeling of the distal aorta. Lastly we co mpared mismatch between donor homograft and pulmonary autograft.Result s: No influence of geometric mismatch between the three valves could b e found on the results of the pulmonary autograft operation. Conclusio n: Good results are obtainable without a painful learning curve if one keeps to certain surgical principles. It need not be a complicated op eration and geometric mismatches between the three valves involved may be compensated for adequately.