The pulmonary autograft--a permanent aortic valve

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Valve Surgery

Background:

• Aortic valve replacement is a common procedure.
• Durability and long-term outcomes of prosthetic valves remain a concern.
• Autologous pulmonary valve (pulmonary autograft) offers a biological alternative.

Purpose of the Study:

• To evaluate the long-term outcomes of aortic valve replacement using the pulmonary autograft (Ross procedure).
• To assess survival, re-operation rates, and valve durability.
• To determine the suitability of this technique for pediatric patients.

Main Methods:

• Retrospective analysis of 339 patients undergoing pulmonary autograft aortic valve replacement between 1969 and 1991.
• Long-term follow-up data collection, including survival, re-operations, and complications.
• Histopathological examination of explanted valves.

Main Results:

• 85% freedom from re-operation at 20 years.
• 80% actuarial patient survival at 20 years.
• No evidence of primary tissue degeneration; explanted valves showed normal cellularity and potential for growth.

Conclusions:

• Pulmonary autograft aortic valve replacement offers excellent long-term results with good survival and durability.
• The absence of anticoagulation requirement and potential for growth make it an ideal option for pediatric patients.
• Technical mal-insertion was a significant factor in late mortality and re-operation.