Excessive pulmonary autograft dilatation causes important aortic regurgitation

Aortic root replacement with reimplantation of the coronary arteries using the pulmonary autograft (PAG) is an accepted operative technique to treat aortic valve disease in children and adults. However, the technically demanding operative technique and lack of long term results regarding function of the PAG limit widespread use. The behaviour of the PAG in the systemic circulation raises concern because of the thinner wall of the pulmonary root and the lesser amount of collagen as compared to the aortic root.1 Severe PAG dilatation may result in aortic regurgitation (AR) and subsequent reoperation. We reviewed our first cohort of adult patients who underwent this operation.2 From January 1989 until May 1995, 37 adult patients (20 male; mean age 29.1 years, range 19.3–52.1 years) underwent aortic root replacement using the PAG for aortic valve disease. The aetiology was bicuspid valve (n = 28), degenerative valve disease (n = 5), cured endocarditis (n = 3), and annuloaortic ectasia (n = 1). The haemodynamic diagnosis was aortic stenosis in 14 patients, regurgitation in 16 patients, and both in seven patients. Standard procedures were applied with regard to cardiopulmonary bypass techniques. The PAG was placed on the left ventricular …