Comparison of autograft and allograft aortic valve replacement in children.
OBJECTIVE
This study was undertaken to compare the clinical and hemodynamic results following aortic valve replacement with a pulmonary valve autograft (Ross procedure) or an allograft valve in children.


METHODS
The records of 107 pediatric aortic valve replacements from 1994 through 2001 were reviewed, including 78 autografts and 25 allografts. Four mechanical aortic valve replacements performed during this period were excluded from analysis.


RESULTS
There were 3 perioperative deaths and 1 late death. Reoperations were required in 5 autograft recipients (with autograft preservation in 4) and in 3 allograft recipients (all requiring valve re-replacement). Seven-year survival (96% in both groups) and reoperation-free survival (88% in the autograft group; 73% in the allograft group, P =.5) were not significantly different. Serial echocardiographic studies showed that in the autograft group, left ventricular outflow tract maximal velocity (2.0-1.8 m/s, P =.02) and left ventricular thickness (10.1-8.4 mm, P <.0001) fell significantly. In the allograft group, maximal velocity (2.3-3.0 m/s, P =.03) increased significantly and left ventricular thickness (9.5-9.0 mm, P =.2) showed minimal change. Analysis according to preoperative physiology (aortic stenosis versus insufficiency), congenital cardiac anatomy, number or type of previous operations, age of patient, and use of balloon valvotomy did not predict outcomes.


CONCLUSIONS
Aortic valve replacement with either the autograft or allograft provides excellent clinical results in children during an intermediate duration of observation. The Ross procedure achieves a superior hemodynamic result, which may be clinically important with longer follow-up.
Lupinetti
Flavian M
FM
Division of Cardiac Surgery, Phoenix Children's Hospital, AZ 85006, USA. fmlupinetti@hotmail.com
Duncan
Brian W
BW
Lewin
Mark
M
Dyamenahalli
Umesh
U
Rosenthal
Geoffrey L
GL
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000637:transplantation*; D001783:Blood Flow Velocity / Q000502:physiology; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D004452:Echocardiography; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000151:congenital / Q000175:diagnosis / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D008943:Mitral Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000637:transplantation; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D011664:Pulmonary Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000637:transplantation; D012086:Reoperation; D016019:Survival Analysis; D013997:Time Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014861:Washington