Pulmonary autograft replacement for malfunctioning aortic valves in children demonstrated excellent function, with 93% actuarial freedom from reoperation at 5.6 years.
Cohort (n=51)
Does pulmonary autograft replacement provide durable function and somatic growth in children requiring aortic valve replacement?
Pulmonary autograft replacement in children offers low operative risk, excellent function, resolution of abnormal LV hemodynamics, and growth potential, making it an ideal option for malfunctioning aortic valves.
Fifty-one children, aged 1.8 to 21 years (mean, 11.4) with aortic valve replacement using a pulmonary autograft are reviewed. Twenty-nine were intra-aortic implants and 22 were root replacements. There was one operative death, no late deaths, and two have required reoperation. Actuarial freedom from reoperation was 93% +/- 5.5 at 5.6 years. Freedom from progression of aortic insufficiency (AI) was 81% +/- 9 at 5.6 years in the intra-aortic implants and 86% +/- 10 in the root replacement. Enlargement of the pulmonary autograft was seen echocardiographically in both groups. This enlargement was consistent with somatic growth and not associated with progression of AI. Ten of 19 patients with aortic stenosis had an LV mass index suggestive of LV hypertrophy before operation. At 1 year, 18 of 25 had a normal LV mass index. Thirteen of 16 patients with AI had preoperative abnormal LV mass index. All but four returned to normal by 1 year. Low operative risk, excellent function, resolution of abnormal LV hemodynamics, and enlargement consistent with somatic growth suggest that the pulmonary autograft is the ideal replacement for the malfunctioning aortic valve.
Elkins et al. (Tue,) conducted a cohort in Malfunctioning aortic valve (n=51). Pulmonary autograft replacement was evaluated on Actuarial freedom from reoperation. Pulmonary autograft replacement for malfunctioning aortic valves in children demonstrated excellent function, with 93% actuarial freedom from reoperation at 5.6 years.