Related Experiment Videos
Pulmonary autograft replacement in children. The ideal solution?
R C Elkins1, K Santangelo, J D Randolph
1University of Oklahoma Health Sciences Center, Oklahoma City 73190.
Annals of Surgery
|September 11, 1992
Summary
The pulmonary autograft is an ideal aortic valve replacement in children, showing excellent function and growth. This procedure offers low risk, with freedom from reoperation at 93% and resolution of heart abnormalities.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Aortic valve disease in children often necessitates valve replacement.
- The pulmonary autograft (Ross procedure) is a viable option for aortic valve replacement in pediatric patients.
- Long-term outcomes and growth characteristics of pulmonary autografts in children require continued evaluation.
Purpose of the Study:
- To review the outcomes of pediatric patients undergoing aortic valve replacement with a pulmonary autograft.
- To assess the functional status, reoperation rates, and echocardiographic findings in children receiving pulmonary autografts.
- To evaluate the impact of pulmonary autograft replacement on left ventricular (LV) mass index and hemodynamics.
Main Methods:
- Retrospective review of 51 children (aged 1.8–21 years) who underwent aortic valve replacement using a pulmonary autograft.
- Categorization of procedures into intra-aortic implants (29) and root replacements (22).
- Analysis of operative mortality, late mortality, reoperation rates, progression of aortic insufficiency (AI), echocardiographic findings, and LV mass index.
Main Results:
- One operative death and no late deaths; 2 patients required reoperation (93% +/- 5.5 freedom from reoperation at 5.6 years).
- Freedom from progression of AI was 81% +/- 9 (intra-aortic) and 86% +/- 10 (root replacement) at 5.6 years.
- Echocardiography showed autograft enlargement consistent with somatic growth, not AI progression. Preoperative LV hypertrophy resolved in most patients within 1 year post-surgery.
Conclusions:
- The pulmonary autograft demonstrates excellent function and low operative risk for pediatric aortic valve replacement.
- Autograft enlargement is physiological, correlating with somatic growth and not adverse AI progression.
- The pulmonary autograft is suggested as the ideal replacement for malfunctioning aortic valves in children, promoting normalization of LV hemodynamics.