Normal Left Ventricular Function Following Pulmonary Autograft Replacement of the Aortic Valve in Children

Abstract

To assess growth potential and hemodynamic sequelae of pulmonary autograft valves implanted into aortic outflow tracts of children, we reviewed our experience with 37 patients (2‐21 years) from August 1986 to December 1990. Twenty patients had predominantly aortic stenosis (AS), and 17 had aortic insufficiency (AI). Operative mortality was 3%. Two technical failures required reoperation. Of survivors, six (18%) have moderate AI. Pre‐ and postoperative echocardiograms were reviewed. The AS group showed increased left ventricular (LV) cavity size by > 1‐year follow‐up, and decreased LV wall and Interventricular septal thickness. In the AI group, wall and septal thickness increased by 10 days and LV cavity decreased by 10 days, 60 days, and > 1 year. Root replacements (n = 14) showed mean increases of 4.3 mm and 5.3 mm, respectively, in diameters of the aortic annulus and aortic sinuses at > 1 year. Intraaortic implants increased 3.1 mm (annulus) and 3.9 mm (sinuses) at > 1 year. The pulmonary autograft procedure is safe, and successful implantation normalizes LV dimensions and function rapidly. The autograft valve shows evidence of growth at > 1 year postoperative. The pulmonary autograft may be the ideal valve replacement in children.

Evolution of aortic valve replacement in children: A single center experience

“…Autograft dilatation (> 40 mm) following a Ross procedure has been demonstrated in several series [11,22,23] and has occurred in 17 patients in our series but only 7 have developed more than mild regurgitation. In 3 of the 7 patients the autograft was replaced with a composite conduit containing a mechanical valve.…”

“…This approach to aortic valve replacement (AVR) makes use of pulmonary valve autograft (a Ross procedure). Results of human valve use for aortic valve replacement in children have been highly favorable [8][9][10][11].…”

The Ross Procedure

“…The Ross procedure, although more complex, could be the best way to preserve left ventricular function when early aortic root replacement is performed. The pulmonary autograft has decreased the long‐term need for reoperation and has improved long‐term survival in patients with congenital aortic valve disease 32 …”

Reversal of Ventricular Dilatation After Correction of Aortic Incompetence: Mechanical Prosthesis Compared With Biological Procedures

“…Mor e re cently, va lve-s pa ring pro ced ures (ao rt ic va lve re pa ir) o r rep lacement of cardiac va lves w it h human va lve tissu e ( ho m ogra ft, autograft) hav e becom e a n al ternat ive, becau se lon gte rm fo llow -up demonstrated significa nt pro sthesis-related co m plicat io n ra te s for a ll pro stheti c valve subs tit utes (8,9, 10). In addi tio n, ao rtic no w velo citi e s a re no rma l in pati ents o pe rated on w it h t he se ne wer te ch niqu es a nd ea rlie r recov e ry from t heir di sea se is suggeste d ( 11,12,13).…”