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Pulmonary autograft replacement of the aortic valve in the potential parent
R C Elkins1, C J Knott-Craig, J D Razook
1Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City 73190.
Insights
Pulmonary autograft replacement (PAR) is a safe and effective aortic valve procedure for young patients, offering long-term viability and avoiding anticoagulants. This method shows a low incidence of valve dysfunction and complications, supporting its use in patients aged 35 or less.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Aortic valve replacement in young individuals is often postponed, leading to multiple procedures.
- Existing prosthetic, bioprosthetic, and allograft valves have shown high complication rates and early failure.
- Pulmonary autograft replacement (PAR) presents a promising alternative for pediatric and young adult aortic valve issues.
Purpose of the Study:
- To evaluate the safety and long-term efficacy of pulmonary autograft replacement (PAR) for aortic valve disease in children and young adults.
- To assess the incidence of valve dysfunction, reoperation, and complications associated with PAR.
- To compare the outcomes of PAR with other aortic valve replacement options.
Main Methods:
- Review of data from 112 patients (ages 1.5-35 years) who underwent PAR for aortic valve disease.
- Analysis of patient demographics, preoperative diagnoses (aortic insufficiency, stenosis, or both), and surgical outcomes.
- Actuarial analysis of survival rates, freedom from reoperation, and freedom from valve-related complications.
Main Results:
- Actuarial survival was 95.4% +/- 2.0% at 7 years post-procedure.
- Freedom from reoperation or significant aortic insufficiency of the autograft valve was 92.7% +/- 3.7%.
- Freedom from all valve-related complications for both autograft and homograft pulmonary valves was 90.0% +/- 4.0%.
Conclusions:
- Pulmonary autograft replacement (PAR) is a safe and effective procedure for aortic valve replacement in children and young adults.
- PAR offers significant advantages, including absence of thromboembolism, avoidance of anticoagulants, and potential for growth and repair.
- The low incidence of late valve dysfunction and complications supports PAR as a viable long-term solution for this patient population.
Abstract:
Aortic valve replacement in the child and young adult is often delayed, and multiple operations or invasive procedures are performed to avoid valve replacements. Prosthetic valves, bioprosthetic valves, or allograft valves have been associated with significant complications or early failure and have been a disappointing solution for the patient requiring aortic valve replacement. The pulmonary autograft replacement (PAR) of the aortic valve in children has been shown to be safe and effective with a low incidence of late valve dysfunction. The absence of thromboembolism, the avoidance of anticoagulants, and its viability with the potential for growth and repair strongly support its use for the potential parent, patients of age 35 or less. The experience with 112 patients, 32 females and 80 males, ages 1.5 to 35 years (average 16.1) are reviewed. Twenty-four had aortic insufficiency, 34 had aortic stenosis, and 54 had both aortic stenosis and insufficiency. Actuarial survival was 95.4% +/- 2.0% at 7 years and freedom from reoperation or significant aortic insufficiency of the autograft valve was 92.7% +/- 3.7%. Freedom from all valve related complications of the autograft valve and the homograft replacement of the pulmonary valve was 90.0% +/- 4.0%. Reoperation for the autograft valve was related to limited experience in one, leaflet prolapse and adherence to a VSD patch in one, associated lupus erythematosus in one, and annular and sinotubular dilatation in one. Reoperation of the homograft valve in two patients was secondary to early homograft stenosis, probably due to rejection.(ABSTRACT TRUNCATED AT 250 WORDS)