The pulmonary autograft: history and basic techniques

The pulmonary autograft introduced in 1967 evolved from the homograft aortic valve, which had been in place 5 years by the time it showed structural deterioration. The strength of the autograft cusps was an initial anxiety, but clinical and experimental studies have shown that they are well able to withstand aortic pressures. The right side reconstruction has been with homografts, first aortic and later pulmonary. Other forms of reconstruction, including autogenous fascia lata and pericardium, have not been satisfactory. Clinical results have been rewarding and suggest a permanent valve replacement. Additionally, there is accumulating evidence that the autograft will grow in young patients. Most surgeons favor root replacement, but there is some anxiety about possible dilatation of the root. This probably relates to technical inadequacies, but subcoronary and inclusion or cylinder insertion remain valid options. There are few contraindications to the use of an autograft, and it has an increasing application in infective and post prosthetic endocarditis.