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The Annals of Thoracic Surgery, Vol 57, 1387-1393, Copyright © 1994 by The Society of Thoracic Surgeons
RC Elkins, CJ Knott-Craig, KE Ward, C McCue and MM Lane
Pulmonary autograft replacement of the aortic valve has the potential to
remain viable and grow in proportion to the somatic growth of the child.
Changes in aortic annulus and sinotubular dimensions were compared early
and late postoperatively, and related to normal. Eighty- six children, 0.9
to 21 years, were operated on between 1986 and 1993: 42 had a root
replacement, 24 an inclusion cylinder, and 20 a scalloped subcoronary
implant. Actuarial survival at 7 years was 96.5% +/- 2.0%. Freedom from
reoperation for the pulmonary autograft or the homograft reconstruction of
the right ventricular outflow tract was 92% +/- 4%. Freedom from
reoperation on the autograft in root replacements was 96% +/- 4%, in the
inclusion cylinder was 100%, and in the scalloped subcoronary was 90% +/-
7% (not significant). Aortic annulus and sinotubular junction diameters
were compared with normal values predicted by body surface area. In 22
intraaortic implants, early and late postoperative annulus diameter mean Z
values are in the normal range. In the 23 root replacements, early annulus
diameter was within the normal range, but late Z values were larger than
normal (p < 0.02). Intraaortic implant annulus diameter increased
proportionally to somatic growth, but the sinotubular junction, which was
small, remained small but increased toward normal. In the root
replacements, the annulus increased in diameter and became dilated. The
sinotubular junction, which was small early, increased and was within the
normal range late. Lower operative risk and valve durability without
failure suggest improved results with inclusion cylinder
technique.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Pulmonary autograft in children: realized growth potential
Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City 73190.
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