Aortic Valve Replacement by Pulmonary Autogrbft: Technical Advances and Follow-up.

ABSTRACT

Background: Autograft is the best choice of graft material in every place especially in cardiac surgery to avoid all type of anti-coagulant related hazard, immunological reactions and considering cost involvement. Study was designed on the basis of above facts. Methods: All patients underwent surgery with standard Cardiopulmonary By-pass under moderate hypothermia using median stemotomy incision. Aortic valve was excised and the right and left coronary buttons were fashioned. Also the pulmonary root was excised. A running suture technique was used to insert the autograft in to the aortic annulus. A pulmonary homograft made by pericardium with three pulmonary valves of appropriate size (22-29 mm) was then inserted. Results: Between July 2001 to July 2002, 30 patients underwent the modified Ross Procedure at La- Pitie Salpitriere Hospital, Paris, France. Out of 30 patients 16 were male and 14 were female with the mean age of 29 years. Indication of operation was aortic stenosis in 6 cases, aortic insufficiency in 9 cases and mixed aortic valve lesion in 15 cases. The mean intra operative cross clamp time was 120 minutes (range 70-170 minutes), mean cardiopulmonary bypass time was 150 minutes (range 110- 195 minutes). Postoperativee chocardiogramsr evealed no significant pulmonary or aortic valvular dysfunction. Three patients, early in the series required reopening for post operative bleeding. Overall a mean of 2.5 units of bloods (0-10) were transfused per patient. Atrial fibrillation occurred in 2 patients which wsre managed accordingly. Among 30 patients, there was one perioperative death (3%), one patient was lost to follow-up and one patient refused to late post operative echocardiography. Twenty four caseso ut of the twenty seven patients available for functional follow-up were in NYHA class I, 2 patients in NYHA class II and one patient in NYHA class III. Conclusions: Pulmonary autografts in aortic position give good short-term result but for its long {erm effrcacy and safety needs more study.