The pulmonary autograft — a permanent aortic valve

Between 1969 and 1991, 339 patients had an aortic valve replacement with their own living pulmonary valve at the National Heart Hospital, Guy's Hospital and the Harley Street Clinic, London. The longest follow-up is 24 years and cumulative follow-up is 3774 patient-years. No form of anticoagulation was used and there were no emboli. There were 25 hospital deaths (7.4%) but only 1 death since 1976. Late deaths occurred in 38 patients mainly from technical mal-insertion. Bacterial endocarditis occurred in 11 patients. Thirty-eight patients were re-operated upon and account for 15 of the late deaths. Freedom from re-operation was 85% and the actuarial patient survival was 80% at 20 years. There has been no evidence of primary tissue degeneration and explanted valves showed normal cusp cellularity. Accumulating evidence suggests that the cusps not only survive permanently but can grow with the patient making the operation ideal for children.