Aortic valve replacement with pulmonary or aortic allografts

Limited availability of aortic valve allografts suggests consideration of pulmonary valve allografts for aortic valve replacement (AVR). From 1987 through 1990, 20 patients underwent AVR with cryopreserved aortic allografts (group 1). Five patients underwent AVR with pulmonary allografts (group 2) because no aortic allografts of the appropriate size were available. Indications for AVR in group 1 were endocarditis in five patients, aortic insufficiency in six, and aortic stenosis in nine. Indications for AVR in group 2 were endocarditis in two patients and aortic insufficiency in three. In group 1 there was one operative death and two late deaths resulting from noncardiac causes. There were no operative or late deaths in group 2. Follow-up was complete (group 1: 1-32 months [mean, 14 months]; group 2: 1-24 months [mean, 13 months]). All surviving patients remain in New York Heart Association (NYHA) class I or II. Postoperative catheterization was performed in 21 of 24 surviving patients. All patients have been followed since hospitalization with serial studies that included computerized cine tomography of the chest and echocardiograms. No false aneurysms, stenoses, or clinically significant regurgitation have occurred, although one patient in group 2 showed 2+ insufficiency at catheterization. One group 1 patient required repeat AVR for recurrent endocarditis. There were no reoperations in group 2. Although longer-term follow-up with larger numbers of patients is necessary, it seems that operative and early postoperative results for AVR have been similar with aortic and pulmonary valve allografts. In selected patients AVR with pulmonary allografts may be appropriate to consider when properly sized aortic allografts are unavailable.