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Ann Thorac Surg 1991;51:424-429
© 1991 The Society of Thoracic Surgeons
The National Heart Hospital, London, England
Accepted for publication November 2, 1990.
* Address reprint requests to Mr Ross, 25 Upper Wimpole St, London W1M 7TA, England.
Between January 1967 and December 1988, 34 patients ranging in age from 3 to 18 years (mean, 14 ± 3.6 years) underwent replacement of the aortic valve or root with their own pulmonary valve. The indication for operation was left ventricular outflow obstruction in 16 patients (47%), aortic regurgitation in 14 (41%), mixed aortic valve disease in 3 (9%), and failure of a previously implanted aortic homograft in 1 (3%). There were four early deaths, all before 1971, giving a hospital mortality of 11.8% (70% confidence interval, 6% to 20%). Surviving patients have been followed up a cumulative total of 214 patient-years, the longest period of observation being 16 years 8 months. Late mortality was 13.3% (70% confidence interval, 7% to 23%), and 4 other patients required removal of the pulmonary autograft for endocarditis. Actuarial rates at 16 years were 74% ± 11% for freedom from reoperation on the left ventricular outflow tract, 80% ± 10% for freedom from reoperation on the right ventricular outflow tract, and 77% ± 10% for late survival. There was no instance of primary structural degeneration in the pulmonary autograft, and all surviving patients were in New York Heart Association functional class I without medication. This experience demonstrates that the pulmonary autograft can achieve good early and medium-term results in young patients. Should growth potential be realized, it might constitute the ideal biological valve for the left ventricular outflow in children.
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