Pulmonary autograft replacement of the aortic valve in children demonstrated 100% freedom from significant aortic regurgitation for root replacement and 91% for intra-aortic implants at 6 years.
Cohort (n=65)
What are the medium-term clinical and echocardiographic outcomes of pulmonary autograft replacement of aortic valves in children?
Pulmonary autograft replacement of the aortic valve in children demonstrates excellent medium-term durability, low mortality, and evidence of annulus growth paralleling somatic growth.
Absolute Event Rate: 100% vs 91%
Pulmonary autograft replacement (PAG) of the aortic valve in children has been shown to be safe and effective with a low incidence of late valve dysfunction. Relief of all types of left ventricular outflow tract obstruction using the pulmonary root has been possible. Concern about the durability of the pulmonary root in the aortic position, and the potential for growth of the pulmonary autograft used either as a root replacement or intraaortic implant, has been questioned. Sixty-five consecutive patients, aged 1.8 to 21 years (mean 12 years) operated on between September 1986 and January 1993, 35 with an intra-aortic implant (IA) and 30 with root replacement (RR), were evaluated by clinical and serial echocardiographic studies (ECHO) up to 6.5 years post-operatively. The hospital mortality rate was 3.0% (70% CL 2.1-5.1%). Two patients required reoperation for PAG insufficiency (AI), one for technical malalignment necessitating replacement at 6 months, and one with progressive leaflet prolapse due to adherence of the valve leaflet to a ventricular septal defect (VSD) patch. Freedom from significant aortic regurgitation at 6-year follow-up was 100% for RR and 91 +/- 6% for IA, and freedom from all valve-related complications including reoperation was 92 +/- 5% at 6 years. Significant enlargement of the aortic annulus which parallels somatic growth has been measured by ECHO in 17 IA implants (P < 0.001) and 17 RR patients (P < 0.01) by 1 year, and in 10 IA (P = 0.007) and 6 RR (P < 0.05) by 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Elkins et al. (Sat,) conducted a cohort in Aortic valve disease requiring replacement (n=65). Pulmonary autograft root replacement (RR) vs. Intra-aortic implant (IA) was evaluated on Freedom from significant aortic regurgitation at 6 years. Pulmonary autograft replacement of the aortic valve in children demonstrated 100% freedom from significant aortic regurgitation for root replacement and 91% for intra-aortic implants at 6 years.