Pulmonary autograft valve replacement in the dilated and asymmetric aortic root.

Abstract

Pulmonary autograft aortic valve replacement is the only technique for implantation of a biologic, vital and thus nondegenerating valve. The technique of root replacement overcomes problems of asymmetric aortic roots and reduces the risk of malalignment, but bears the risk of dilatation. We have performed pulmonary autograft aortic root replacement in 20 patients (mean age 22 years, range 5-38). Twelve presented with aortic incompetence, 3 with stenosis and 5 with combined defects. Initially roots were implanted just supraannularly with two running suture lines. As the neo-aortic roots gradually dilated, we started to implant autografts intraannulary, but still one valve dilated and aortic incompetence (AI) increased from grade I to II. Consequently the remaining aortic wall was wrapped around the new root and the composite subsequently was reinforced by a circular absorbable mesh. In addition, the aorta and pulmonary valve were exactly sized and the aortic root was reduced by commissuroplasty stitches up to 6 mm in diameter in seven cases. The ventricular size decreased in all patients 10 days after surgery, the left ventricular end-diastolic diameters (LVEDD) from 58 +/- 12 to 52 +/- 10 mm (P = 0.0002; paired t-test) and left ventricular end-systolic diameter (LVESD) from 41 +/- 12 to 36 +/- 10 mm (P = 0.008), but the contractility did not change significantly (fractional shortening from 31 +/- 9% to 30 +/- 9%). The diameter of the new aortic ring increased for the supraannular position but size matching and the intraannular valve position reduced the new ring size significantly (P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)