Pediatric Autograft Aortic Root Replacement: A Prospective Follow-Up Study

Abstract

The autograft procedure offers children who require aortic valve replacement the advantage of an autologous valve that has growth potential and does not require anticoagulation. However, the autograft procedure is a double valve operation and its durability depends on the lifetime of both the autograft and the pulmonary valve substitute. We present our clinical experience with pediatric autograft aortic root replacement. Between September 1988 and September 2003, 47 children (mean age, 8 years; standard deviation, 5 years; range, 3 months to 15 years) underwent autograft aortic root replacement. Perioperative characteristics and annual follow-up information were collected prospectively. The male to female ratio was 32 to 15. Eighty-nine percent of patients had congenital aortic valve disease, 47% of patients previously underwent cardiac surgery, and 43% had an aortic valve balloon dilatation. Concomitant left ventricular outflow tract enlargement was performed in 19 patients. In all cases the pulmonary valve was replaced using an allograft. There were no hospital deaths. Mean follow-up was 6.1 years (median 5.4; range, 1 month to 15 years; total of 284 patient years). During follow-up 3 patients died. Cumulative survival was 95% at 1 year and 93% at 12 years. One patient had endocarditis of the pulmonary allograft develop. Three patients required reoperation; two patients for allograft degeneration at 9.4 and 12.8 years, and 1 for combined autograft dilatation and allograft degeneration at 7.7 years postoperatively. Freedom from valve-related reoperation was 86% at 12 years. Pediatric autograft aortic root replacement is associated with acceptable mortality and reoperation rates in the first decade postoperatively. It allows most children to grow into adulthood without the need for anticoagulation and additional valve replacements.