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Ann Thorac Surg 1999;67:1846-1848
© 1999 The Society of Thoracic Surgeons

Aortic allografts and pulmonary autografts for replacement of the aortic valve and aortic root

^a The Heart Center, Missouri Baptist Medical Center, St. Louis, Missouri, USA

Address reprint requests to Dr Kouchoukos, 3009 N. Ballas Rd, Suite 266C, St. Louis, MO 63131

Presented at the Aortic Surgery Symposium VI, April 30–May 1, 1998, New York, NY.

Background. Extensive experience has accumulated with the use of aortic and pulmonary autografts for replacement of the aortic valve and the aortic root. Three general techniques for insertion have been used: subcoronary (free-hand) valve implantation, mini- or inclusion-root implantation, and aortic root replacement. Thirty-day mortality for elective operations with all of these techniques has not exceeded 5%. Thromboembolic episodes have been rare, and endocarditis has occurred infrequently. Early hemodynamic performance has been excellent, without significant gradients or valve regurgitation in the majority of patients.

Methods and Results. Progressive aortic regurgitation has been observed with continued follow-up, and is the most important complication of both types of valves. Leaflet failure and technical problems are the major causes of reoperation for patients receiving aortic allografts. There is some evidence to suggest that the prevalence of these complications is lower with the root replacement technique than with the intraaortic implantation methods.

Conclusions. Reoperation for regurgitation of the neo-aortic valve is the major complication of the pulmonary autograft procedure. The incidence of reoperation appears to be lowest with the root replacement technique. Certain conditions (acute rheumatic fever, juvenile rheumatoid arthritis, systemic lupus, ankylosing spondylitis, Libman-Sachs endocarditis, and possibly a dilated aortic root) may be contraindications to the use of a pulmonary autograft. Reoperation on the pulmonary allograft that is used to replace the autograft may be necessary in up to 20% of patients at 20 years.

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