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The pulmonary autograft: results and left ventricular function
1Cardiac Surgery Department, U.C.L. St-Luc, Brussels, Belgium.
Seminars in Thoracic and Cardiovascular Surgery
|October 1, 1996
Summary
Pulmonary autografts for aortic valve replacement show excellent outcomes, with low mortality and no morbidity. This procedure effectively normalizes left ventricular (LV) function in most patients, demonstrating its therapeutic value.
Area of Science:
- Cardiovascular Surgery
- Cardiac Transplantation
- Echocardiography
Background:
- Aortic valve disease necessitates surgical intervention, with various prosthetic options available.
- The pulmonary autograft (Ross procedure) is a viable alternative for aortic valve replacement, particularly in younger patients.
- Understanding the long-term impact on left ventricular (LV) function is crucial for assessing the efficacy of this procedure.
Purpose of the Study:
- To evaluate the clinical outcomes and echocardiographic findings following aortic valve replacement using pulmonary autografts.
- To assess the impact of pulmonary autograft implantation on left ventricular (LV) dimensions, mass, and function.
- To identify factors influencing LV functional recovery after aortic valve replacement with pulmonary autografts.
Main Methods:
- A retrospective analysis of 60 patients who underwent aortic valve replacement with pulmonary autografts between June 1991 and January 1996.
- Preoperative and serial postoperative transthoracic echocardiography to assess aortic and pulmonary annuli, gradients, incompetence, and LV function.
- Intraoperative transesophageal echocardiography was routinely employed.
Main Results:
- A low early postoperative mortality rate of 2% and no late deaths were observed.
- All survivors remained in New York Heart Association class I, free of complications and medications, with no significant aortic incompetence or gradients.
- Pulmonary autografts normalized LV dimensions and mass in most patients within 1-3 months post-surgery, leading to improved LV function and reduced wall stress.
Conclusions:
- Aortic valve replacement with pulmonary autografts yields excellent clinical results with minimal mortality and morbidity.
- The procedure effectively eliminates abnormal LV loading conditions, promoting complete LV functional recovery in the majority of patients.
- Pulmonary autografts represent a highly effective treatment option for aortic valve disease, particularly concerning LV remodeling and function.