Two decades' experience with aortic valve replacement with pulmonary autograft

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Valve Repair & Replacement

Background:

• Aortic valve replacement (AVR) is a critical procedure for severe aortic valve disease.
• The use of autografts, particularly the pulmonary autograft (PA), has been explored as an alternative to mechanical or bioprosthetic valves.
• Long-term outcomes and safety profiles of PA AVR require continued evaluation.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of aortic valve replacement using a pulmonary autograft.
• To assess survival rates, thromboembolic events, endocarditis incidence, and reoperation rates associated with this technique.
• To compare the outcomes of PA AVR with other reconstructive methods for the right ventricular outflow tract.

Main Methods:

• A retrospective analysis of 241 patients undergoing AVR with a pulmonary autograft between June 1967 and October 1986.
• Comprehensive follow-up data collection, including mortality, morbidity, and reoperation status.
• Calculation of actuarial survival and event-free rates, with a cumulative follow-up of 1130 patient-years.

Main Results:

• The 30-day mortality was 6.6%, with no perioperative deaths after 1976. Late mortality was 1.7%/pt-yr.
• Actuarial survival reached 57.3% +/- 9.6% at 19 years, with no thromboembolic episodes reported.
• Bacterial endocarditis occurred in 1.2%/pt-yr (14 patients), and reoperation for graft failure was needed in 36 patients (2.5%/pt-yr).

Conclusions:

• Pulmonary autograft aortic valve replacement demonstrates satisfactory long-term results, including good survival and freedom from anticoagulation-related complications.
• The procedure is safe and effective, supporting its recommendation for a wider range of patients.
• Pulmonary homografts are now preferred over aortic homografts for right ventricular outflow tract reconstruction due to favorable outcomes.