Use of the pulmonary autograft for mitral replacement: short- and medium-term experience

Objectives: In an effort to find a suitable mitral substitute for our young rheumatic patients who cannot follow a proper anticoagulation regimen for life, we resorted to an old concept reported by one of the authors (D.N.R.) in 1967. This report summarizes our experience with the Ross-mitral operat ion to date. Methods: Between 19 June 1997 and 27 June 2000, 43 patients wi th rheumatic valve disease underwent the Ross-mitral operation. Two patient s were excluded because of craft stenosis detected at the end of the proced ure for which the autograft had to be sacrificed. Of the remaining 41 patie nts 29 were female, and the age range was 12-57 years (median 39 years). Th e autograft was incorporated within a Dacron tubing, with a pericardial col lar attached to its proximal end. The conduit was sutured distally to the e xcised mitral annulus; the pericardium was attached proximally to the atria l wall in 36 patients, and was used simply to cover the Dacron tubing in fi ve patients. The pulmonary artery was replaced with a pulmonary or aortic h omograft, or with a pulmonary xenograft. Results: There were two hospital f atalities from a cerebrovascular accident and a lung injury, and two postop erative myocardial infarctions. There were five late deaths, two due to bac terial endocarditis, one due to excessive bleeding at reoperation for a par avalvular leak, and two not related to the procedure. A phenomenon of 'auto graft stenosis' occurred intraoperatively in four recent consecutive patien ts that probably resulted from our use, for the first time, of softer Dacro n tubing material. This was repaired in two of the four patients. Echocardi ography confirmed excellent functioning of all 34 autografts of surviving p atients up to 36 months postoperatively (mean follow-up 18.2 months). Two p atients remain in functional Class III status, one due to left heart failur e following myocardial infarction, and the other due to recurrent tricuspid insufficiency. Conclusions: We believe that the mitral pulmonary autograft is a worthwhile alternative to mechanical prostheses in developing countri es. (C) 2001 Elsevier Science B.V. All rights reserved.