The fate of the pulmonary autograft in the aortic position: experience and results of 98 patients in twelve years.
OBJECTIVE
The ideal prosthesis for aortic valve replacement in infants and adolescents is still controversially discussed. Implantation of mechanical prostheses or homografts is associated with serious risks such as reoperations, thromboembolic events and infections. This has led many surgeons to prefer the Ross operation.


METHODS
Between 1996 and 2008 we performed Ross operations in 98 children and infants with a mean age of 11 years (range 1 mo-25 y), including concomitant procedures (n = 33). The operation was performed as a full-root replacement in 97 and as a subcoronary implantation in one patient. The patients were followed for up to twelve years (follow-up complete) to determine clinical and echocardiographic parameters. Mean duration of follow-up was 60 +/- 37 (range 3-150 months).


RESULTS
Overall survival was 98 % (n = 96). In 70 patients (71.4 %) no autograft insufficiency (AI) could be observed. AI grade I was present in 22 patients (22.4 %), AI grade II in 3 patients (3 %), and AI grade III in one patient. The autograft in the latter patient was replaced by a mechanical prosthesis. Aortic root dilatation was observed in 10 patients (10.2 %). Z-score (median) in these patients was 4.1 (normal z-score < or = 2.4). One patient with aortic root dilatation was reoperated. A pacemaker was implanted in two patients. No patient is on constant anticoagulants.


CONCLUSIONS
The anatomy and physiology of the LVOT is best restored by the implantation of a pulmonary autograft. This additionally provides a growth potential for infants at low risk for reoperations. Autograft dilatation is a risk that requires constant evaluation.
Valeske
K
K
Children's Heart Center and Cardiovascular Surgery, University Giessen/Marburg, Giessen, Germany. Klaus.Valeske@chiru.med.uni-giessen.de
Müller
M
M
Hijjeh
N
N
Bauer
J
J
Böning
A
A
Schranz
D
D
Akintürk
H
H
D000293:Adolescent; D000328:Adult; D001014:Aortic Aneurysm / Q000209:etiology / Q000601:surgery; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D005858:Germany; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D011651:Pulmonary Artery / Q000637:transplantation*; D012086:Reoperation; D018570:Risk Assessment; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult