(Circulation. 1999;100:II-103.)
© 1999 American Heart Association, Inc.
Surgery for Valvular Heart Disease |
Pulmonary Autograft Versus Aortic Homograft for Rereplacement of the Aortic Valve
Results From a Subset of a Prospective Randomized Trial
From the Department of Academic Surgery, National Heart and Lung Institute, Royal Brompton Hospital, Sydney Street, London, UK.
Correspondence to Prof Sir Magdi Yacoub, Department of Cardiothoracic Surgery, National Heart and Lung Institute, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. E-mail g.carr-white{at}rbh.nthames.nhs.uk
Background—The use of a pulmonary autograft for rereplacement of the aortic valve has both potential advantages and disadvantages. This study details the early results of a subset of patients enrolled in a prospective randomized trial comparing pulmonary autografts and aortic homografts who have had previous aortic valve replacements.
Methods and Results—A total of 47 patients who had undergone 
1
previous aortic valve replacement were randomized to receive either a
pulmonary autograft (24 patients aged 40±11 years) or an
aortic homograft (23 patients aged 37±11 years) for rereplacement of
the aortic valve. One early death occurred in the homograft group, and
1 late (7 months) death occurred in the autograft group. One patient
who received a pulmonary autograft was reoperated on for
inflammatory pulmonary stenosis. One patient in each
group was reopened for bleeding (both within 24 hours). Two patients in
the autograft group had postoperative neurological weakness; they fully
recovered over 2 months. Hospital stay, blood loss, incidence of
perioperative arrhythmia, and markers of
coronary ischemia were similar between the 2 groups. At
6-month follow-up (range, 1 to 12 months), left ventricular
end-diastolic diameter was similar in both groups
(homografts, 5.0±0.9 cm; autografts, 5.2±0.6 cm;
P=NS), and no patient in either group had significant
aortic valve dysfunction.
Conclusions—Rereplacement of the aortic valve with a pulmonary autograft is feasible and safe in patients aged 14 to 60, regardless of their preoperative diagnosis or clinical condition.
Key Words: aorta • valves • autograft • surgery